European Heart Journal Advance Access originally published online on November 8, 2008
European Heart Journal 2009 30(2):162-169; doi:10.1093/eurheartj/ehn504
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Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35
1 TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
2 Department of Medicine, Harvard Medical School, Boston, MA, USA
3 Donald W. Reynolds Cardiovascular Clinical Research Center, Brigham and Women's Hospital, Boston, MA, USA
4 Donald W. Reynolds Cardiovascular Clinical Research Center and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
5 Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
Received 14 August 2008; revised 10 October 2008; accepted 16 October 2008; online publish-ahead-of-print 8 November 2008.
* Corresponding author. Tel: +1 617 278 0145, Fax: +1 617 734 7329, Email: msabatine{at}partners.org
See page 127 for the editorial comment on this article (doi:10.1093/eurheartj/ehn555)
Aims: To determine whether an ultrasensitive assay can permit quantification of changes in circulating cardiac troponin (Tn) in the setting of stress test-induced myocardial ischaemia.
Methods and results: Blood samples were obtained before, immediately after, and 2 and 4 h after stress testing with nuclear perfusion imaging in 120 patients. Troponin was measured using commercial assays as well as with a novel, ultrasensitive cardiac TnI assay with a limit of detection of 0.2 pg/mL. Using the ultrasensitive assay, TnI was detectable in all patients before stress testing (median 4.4 pg/mL, interquartile range 3.1–8.6 pg/mL). By 4 h, troponin levels were unchanged in patients without ischaemia, whereas circulating levels had increased by a median of 1.4 pg/mL (24% increase) in patients with mild ischaemia (P = 0.002) and by 2.1 pg/mL (40% increase) in patients with moderate-to-severe ischaemia (P = 0.0006). In contrast, changes in troponin levels across patients in different ischaemic categories were indistinguishable using commercial troponin assays. When added to clinical factors, a >1.3 pg/mL increase in TnI using the ultrasensitive assay was an independent predictor of ischaemia (odds ratio 3.54, P = 0.007).
Conclusion: Transient stress test-induced myocardial ischaemia is associated with a quantifiable increase in circulating troponin that is detectable with a novel, ultrasensitive TnI assay.
Key Words: Troponin • Myocardial ischaemia • Stress test
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