Association Between High-Sensitivity Cardiac Troponin Levels and Myocardial Ischemia During Mental Stress and Conventional Stress

JACC-CARDIOVASCULAR IMAGING

卷:11

Article

Hammadah, Muhammad¹  Al Mheid, Ibhar¹  Wilmot, Kobina¹  Ramadan, Ronnie¹  Alkhoder, Ayman¹  Obideen, Malik¹  Abdelhadi, Naser¹  Fang, Shuyang^1,2  Ibeanu, Ijeoma²  Pimple, Pratik²  Kelli, Heval Mohamed¹  Shah, Amit J.^1,2  Pearce, Brad²  Sun, Yan²  Garcia, Ernest V.³  Kutner, Michael⁴  Long, Qi²  Ward, Laura⁴  Bremner, J. Douglas⁵  Esteves, Fabio³  Raggi, Paolo^2,3,6  Sheps, David⁷  Vaccarino, Viola^1,2  Quyyumi, Arshed A.¹ 

[1] Emory Univ, Sch Med, Div Cardiol, Dept Med, Atlanta, GA 30322 USA

[2] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA

[3] Emory Univ, Sch Med, Dept Radiol, Atlanta, GA 30322 USA

[4] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, Atlanta, GA 30322 USA

[5] Emory Univ, Sch Med, Dept Psychiat & Behav Sci, Atlanta, GA USA

[6] Univ Alberta, Mazankowski Alberta Heart Inst, Edmonton, AB, Canada

[7] Univ Florida, Dept Epidemiol, Gainesville, FL USA

关键词: high-sensitivity troponin I;    mental stress;    myocardial ischemia;    physical stress;   

DOI  :  10.1016/j.jcmg.2016.11.021

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to investigate whether patients with mental stress-induced myocardial ischemia will have high resting and post-mental stress high-sensitivity cardiac troponin I (hs-cTnI). BACKGROUND Hs-cTnI is a marker of myocardial necrosis, and its elevated levels are associated with adverse outcomes. Hs-cTnI levels may increase with exercise in patients with coronary artery disease. Mental stress-induced myocardial ischemia is also linked to adverse outcomes. METHODS In this study, 587 patients with stable coronary artery disease underwent technetium Tc 99m sestamibi-single-photon emission tomography myocardial perfusion imaging during mental stress testing using a public speaking task and during conventional (pharmacological/exercise) stress testing as a control condition. Ischemia was defined as new/worsening impairment in myocardial perfusion using a 17-segment model. RESULTS The median hs-cTnI resting level was 4.3 (interquartile range [IQR]: 2.9 to 7.3) pg/ml. Overall, 16% and 34.8% of patients developed myocardial ischemia during mental and conventional stress, respectively. Compared with those without ischemia, median resting hs-cTnI levels were higher in patients who developed ischemia either during mental stress (5.9 [IQR: 3.9 to 8.3] pg/ml vs. 4.1 [IQR: 2.7 to 7.0] pg/ml; p < 0.001) or during conventional stress (5.4 [IQR: 3.9 to 9.3] pg/ml vs. 3.9 [IQR: 2.5 to 6.5] pg/ml; p < 0.001). Patients with high hs-cTnI (cutoff of 4.6 pg/ml for men and 3.9 pg/ml for women) had greater odds of developing mental (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.5 to 3.9; p < 0.001) and conventional (OR: 2.4; 95% CI: 1.7 to 3.4; p < 0.001) stress-induced ischemia. Although there was a significant increase in 45-min post-treadmill exercise hs-cTnI levels in those who developed ischemia, there was no significant increase after mental or pharmacological stress test. CONCLUSIONS In patients with coronary artery disease, myocardial ischemia during either mental stress or conventional stress is associated with higher resting levels of hs-cTnI. This suggests that hs-cTnI elevation is an indicator of chronic ischemic burden experienced during everyday life. Whether elevated hs-cTnI levels are an indicator of adverse prognosis beyond inducible ischemia or whether it is amenable to intervention requires further investigation. (c) 2018 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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