Clinical InvestigationClinical benefit of high-sensitivity cardiac troponin I in the detection of exercise-induced myocardial ischemia
Section snippets
Patient population
From January 2010 to July 2012, consecutive patients referred to the University Hospital Basel for CAD evaluation by rest/bicycle myocardial perfusion SPECT were recruited for the “Biomarkers and ECG signals in exercise-induced myocardial ischemia” (BASEL VIII) study. We took advantage of a unique setting in which myocardial perfusion SPECT is the cardiac stress test of choice for patients with a wide range of pretest probability for CAD.
For this analysis, we only included patients who
Patient characteristics
The baseline characteristics of the 819 patients are shown in Table I. Exercise-induced myocardial ischemia was present in 278 (34%) patients. Patients with exercise-induced myocardial ischemia were more often male and had more cardiovascular risk factors.
Hs-cTnI measurements before and after exercise testing
High-sensitivity cTnI levels before and after exercise testing are shown in Table II and Figure 1. Baseline hs-cTnI levels above the assay's limit of detection of 0.1 ng/L were measured in 813 patients (99%). High-sensitivity cTnI levels
Discussion
This large diagnostic study was designed to investigate whether hs-cTnI measurements before and after stress testing to assess exercise-induced changes provide clinical benefit in the detection of exercise-induced myocardial ischemia, which may go beyond that observed for resting concentrations of hs-cTnI.9 We report 5 major findings. First, baseline, peak exercise, and 2-hour hs-cTnI levels were significantly higher in patients with exercise-induced myocardial ischemia as compared with
Disclosures
Professor Mueller has received research grants from the Swiss National Science Foundation, the Swiss Commission for technology and innovation, the European Union, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, 8sense, Abbott, ALERE, Astra Zeneca, Biomerieux, Brahms, Critical Diagnostics, Nanosphere, Roche, Siemens, Singulex, Sphingotec, and the University Hospital Basel, as well as speaker/consultancy honoraria from Abbott, ALERE, Astra Zeneca, Biomerieux,
Acknowledgments
We thank the patients who participated in the study, the staff of the nuclear medicine department, and the laboratory technicians (particularly Melanie Wieland, Kathrin Meissner, Irina Klimmeck, and Fausta Chiaverio) for their most valuable efforts.
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