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Research ArticleGeneral Clinical Chemistry

Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy

Peder L. Myhre, Torbjørn Omland, Sebastian I. Sarvari, Heikki Ukkonen, Frank Rademakers, Jan E. Engvall, Tor-Arne Hagve, Eike Nagel, Rosa Sicari, Jose L. Zamorano, Mark Monaghan, Jan D'hooge, Thor Edvardsen, Helge Røsjø
DOI: 10.1373/clinchem.2018.288894 Published June 2018
Peder L. Myhre
Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway;Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA;
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Torbjørn Omland
Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway;
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Sebastian I. Sarvari
Department of Cardiology, Oslo University Hospital, Rikshospitalet and Center for Heart Failure Research, University of Oslo, Oslo, Norway;
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Heikki Ukkonen
Department of Medicine, Turku University Hospital, Turku, Finland;
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Frank Rademakers
Department of Cardiovascular Sciences, University Hospitals Leuven and KU Leuven, Leuven, Belgium;
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Jan E. Engvall
Department of Clinical Physiology Linköping University, Linköping, Sweden and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden;
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Tor-Arne Hagve
Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog and Institute of Clinical Medicine, University of Oslo, Oslo, Norway;
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Eike Nagel
Kings College Hospital, Department of Non-invasive Cardiology, Denmark Hill, London, UK;
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Rosa Sicari
CNR, Istituto di Fisiologia Clinica, Pisa, Italy;
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Jose L. Zamorano
Hospital Universitario Ramón y Cajal, Cardiovascular Imaging Unit, Madrid, Spain.
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Mark Monaghan
Kings College Hospital, Department of Non-invasive Cardiology, Denmark Hill, London, UK;
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Jan D'hooge
Department of Cardiovascular Sciences, University Hospitals Leuven and KU Leuven, Leuven, Belgium;
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Thor Edvardsen
Department of Cardiology, Oslo University Hospital, Rikshospitalet and Center for Heart Failure Research, University of Oslo, Oslo, Norway;
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Helge Røsjø
Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway;
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  • For correspondence: helge.rosjo@medisin.uio.no
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Abstract

Background: Cardiac troponin T concentrations measured with high-sensitivity assays (hs-cTnT) provide important prognostic information for patients with stable coronary artery disease (CAD). However, whether hs-cTnT concentrations mainly reflect left ventricular (LV) remodeling or recurrent myocardial ischemia in this population is not known.

Methods: We measured hs-cTnT concentrations in 619 subjects with suspected stable CAD in a prospectively designed multicenter study. We identified associations with indices of LV remodeling, as assessed by cardiac MRI and echocardiography, and evidence of myocardial ischemia diagnosed by single positron emission computed tomography.

Results: Median hs-cTnT concentration was 7.8 ng/L (interquartile range, 4.8–11.6 ng/L), and 111 patients (18%) had hs-cTnT concentrations above the upper reference limit (>14 ng/L). Patients with hs-cTnT >14 ng/L had increased LV mass (144 ± 40 g vs 116 ± 34 g; P < 0.001) and volume (179 ± 80 mL vs 158 ± 44 mL; P = 0.006), lower LV ejection fraction (LVEF) (59 ± 14 vs 62 ± 11; P = 0.006) and global longitudinal strain (14.1 ± 3.4% vs 16.9 ± 3.2%; P < 0.001), and more reversible perfusion defects (2.4 ± 3.2 points vs 1.2 ± 2.0 points; P = 0.001) and reversible wall motion abnormalities (3.0 ± 7.5 points vs 0.7 ± 4.3 points; P < 0.001). Age (P = 0.009), estimated glomerular filtration rate (P = 0.01), LV mass (P = 0.003), LVEF (P = 0.03), and evidence of reversible myocardial ischemia (P = 0.004 for perfusion defects and P = 0.02 for LV wall motion) were all associated with increasing hs-cTnT concentrations in multivariate analysis. We found analogous results when using the revised US upper reference limit of 19 ng/L.

Conclusions: hs-cTnT concentrations reflect both LV mass and reversible myocardial ischemia in patients with suspected stable CAD.

  • Received for publication March 10, 2018.
  • Accepted for publication June 1, 2018.
  • © 2018 American Association for Clinical Chemistry

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Clinical Chemistry: 65 (2)
Vol. 65, Issue 2
February 2019
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Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy
Peder L. Myhre, Torbjørn Omland, Sebastian I. Sarvari, Heikki Ukkonen, Frank Rademakers, Jan E. Engvall, Tor-Arne Hagve, Eike Nagel, Rosa Sicari, Jose L. Zamorano, Mark Monaghan, Jan D'hooge, Thor Edvardsen, Helge Røsjø
Clinical Chemistry Jan 2018, clinchem.2018.288894; DOI: 10.1373/clinchem.2018.288894
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Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy
Peder L. Myhre, Torbjørn Omland, Sebastian I. Sarvari, Heikki Ukkonen, Frank Rademakers, Jan E. Engvall, Tor-Arne Hagve, Eike Nagel, Rosa Sicari, Jose L. Zamorano, Mark Monaghan, Jan D'hooge, Thor Edvardsen, Helge Røsjø
Clinical Chemistry Jan 2018, clinchem.2018.288894; DOI: 10.1373/clinchem.2018.288894

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