Abstract 17538: Baseline High Sensitivity Cardiac Troponin-T Can Identify Reversible Myocardial Ischemia Even in the Presence of LV Systolic Dysfunction
Background: Detectable levels of cardiac troponin-T by high sensitivity assay (hs-TnT) are elevated by both ischaemia and LV systolic dysfunction (LVSD) but it is unknown whether hs-TnT could be a useful biomarker to identify ischaemia either in the presence or the absence of LVSD. Hypothesis: Reversible myocardial ischemia can be identified by hs-TnT even in the presence of LVSD.
Methods: 500 consecutive patients undergoing a clinically indicated dipyridamole myocardial perfusion scintigraphy were studied. Those with impaired renal functions and history of atrial fibrillation or valvular disease were excluded. The troponin-T levels were measured in serum using a highly sensitive assay on an automated platform (Elecsys E170, Roche Diagnostics, lower limit of detection 3ng/L). All scans were interpreted by a trained physician blinded to the biomarker data. Patients were divided into four groups based on reversible ischemia and stress ejection fraction (EF) on gated SPECT imaging.
Results: Data were available for 453 patients and 97/453 had a reversible ischemic defect. hsTnT levels were significantly higher in patients with a reversible ischemia [Median (IQR) 7.2 (3.3 - 10.9) vs. 4.2 (3.0 - 7.5) pg / ml p<0.001] compared to those without. When analysed according to four groups based on LV function and reversible ischemia, hsTnT levels were highest in patients with ischemia and a low EF and lowest in patients with no ischemia and normal EF (pTREND <0.001) as shown in the table. In a multivariate model which included age, gender, cardiovascular co-morbidities, eGFR, haemoglobin, BNP, and LV ejection fraction, hs-TnT remained an independent predictor of reversible perfusion defect (p=0.026).
Conclusions: Baseline hs-cTnT levels are an independent predictor of reversible myocardial ischemia and this is still the case in the presence of LVSD.
- © 2012 by American Heart Association, Inc.