High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction

Abdallah El Sabbagh, Megha Prasad, Chad Zack, Robert J. Widmer, Brad S. Karon, Amir Lerman, Allan S. Jaffe

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Coronary endothelial dysfunction (CED) is associated with recurrent ischemia. The role of high-sensitivity cardiac troponin I (hscTnI) levels in patients with CED has not been established. METHODS: Patients with suspected ischemia, who underwent clinically indicated coronary angiography and were found to have non-obstructive coronary artery disease, were included in the study. CED was defined as ≤50% increase in coronary blood flow from baseline and/or a decrease in epicardial coronary artery diameter >20% in response to maximal dosages of acetylcholine. HscTnI was measured at the time of the procedure using the Architect hscTnI assay (Abbott). RESULTS: Of 299 patients, 60 had normal endothelial function and 239 patients had abnormal endothelial function. The median age of the population was 52 years (interquartile range [IQR], 45-60 years). Patients with abnormal endothelial function had significantly higher log hscTnI values when compared to patients with normal endothelial function (0.9 ng/L [IQR, 0.7-1.4 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.04). An hscTnI value >12.5 ng/L was 100% specific for the presence of endothelial dysfunction (100% positive predictive value). There were 39 major adverse cardiovascular events during follow-up. In patients with normal endothelial function, hscTnI levels were significantly higher in patients who developed major adverse cardiac events when compared to patients who did not (1.35 ng/L [IQR, 1.1-2.1 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.02). CONCLUSION: Our findings suggest that endothelial dysfunction may be associated with higher baseline hscTnI levels, suggesting increased myocardial injury in this population of patients. Additional studies are necessary to further define the role of hscTnI in risk stratification in this population.

Original languageEnglish (US)
Pages (from-to)406-410
Number of pages5
JournalJournal of Invasive Cardiology
Volume30
Issue number11
StatePublished - Nov 1 2018

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Troponin
Troponin I
Coronary Vessels
Ischemia
Population
Coronary Angiography
Acetylcholine
Coronary Artery Disease

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

El Sabbagh, A., Prasad, M., Zack, C., Widmer, R. J., Karon, B. S., Lerman, A., & Jaffe, A. S. (2018). High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction. Journal of Invasive Cardiology, 30(11), 406-410.
El Sabbagh, Abdallah ; Prasad, Megha ; Zack, Chad ; Widmer, Robert J. ; Karon, Brad S. ; Lerman, Amir ; Jaffe, Allan S. / High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction. In: Journal of Invasive Cardiology. 2018 ; Vol. 30, No. 11. pp. 406-410.
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abstract = "BACKGROUND: Coronary endothelial dysfunction (CED) is associated with recurrent ischemia. The role of high-sensitivity cardiac troponin I (hscTnI) levels in patients with CED has not been established. METHODS: Patients with suspected ischemia, who underwent clinically indicated coronary angiography and were found to have non-obstructive coronary artery disease, were included in the study. CED was defined as ≤50{\%} increase in coronary blood flow from baseline and/or a decrease in epicardial coronary artery diameter >20{\%} in response to maximal dosages of acetylcholine. HscTnI was measured at the time of the procedure using the Architect hscTnI assay (Abbott). RESULTS: Of 299 patients, 60 had normal endothelial function and 239 patients had abnormal endothelial function. The median age of the population was 52 years (interquartile range [IQR], 45-60 years). Patients with abnormal endothelial function had significantly higher log hscTnI values when compared to patients with normal endothelial function (0.9 ng/L [IQR, 0.7-1.4 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.04). An hscTnI value >12.5 ng/L was 100{\%} specific for the presence of endothelial dysfunction (100{\%} positive predictive value). There were 39 major adverse cardiovascular events during follow-up. In patients with normal endothelial function, hscTnI levels were significantly higher in patients who developed major adverse cardiac events when compared to patients who did not (1.35 ng/L [IQR, 1.1-2.1 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.02). CONCLUSION: Our findings suggest that endothelial dysfunction may be associated with higher baseline hscTnI levels, suggesting increased myocardial injury in this population of patients. Additional studies are necessary to further define the role of hscTnI in risk stratification in this population.",
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El Sabbagh, A, Prasad, M, Zack, C, Widmer, RJ, Karon, BS, Lerman, A & Jaffe, AS 2018, 'High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction', Journal of Invasive Cardiology, vol. 30, no. 11, pp. 406-410.

High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction. / El Sabbagh, Abdallah; Prasad, Megha; Zack, Chad; Widmer, Robert J.; Karon, Brad S.; Lerman, Amir; Jaffe, Allan S.

In: Journal of Invasive Cardiology, Vol. 30, No. 11, 01.11.2018, p. 406-410.

Research output: Contribution to journalArticle

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T1 - High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction

AU - El Sabbagh, Abdallah

AU - Prasad, Megha

AU - Zack, Chad

AU - Widmer, Robert J.

AU - Karon, Brad S.

AU - Lerman, Amir

AU - Jaffe, Allan S.

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N2 - BACKGROUND: Coronary endothelial dysfunction (CED) is associated with recurrent ischemia. The role of high-sensitivity cardiac troponin I (hscTnI) levels in patients with CED has not been established. METHODS: Patients with suspected ischemia, who underwent clinically indicated coronary angiography and were found to have non-obstructive coronary artery disease, were included in the study. CED was defined as ≤50% increase in coronary blood flow from baseline and/or a decrease in epicardial coronary artery diameter >20% in response to maximal dosages of acetylcholine. HscTnI was measured at the time of the procedure using the Architect hscTnI assay (Abbott). RESULTS: Of 299 patients, 60 had normal endothelial function and 239 patients had abnormal endothelial function. The median age of the population was 52 years (interquartile range [IQR], 45-60 years). Patients with abnormal endothelial function had significantly higher log hscTnI values when compared to patients with normal endothelial function (0.9 ng/L [IQR, 0.7-1.4 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.04). An hscTnI value >12.5 ng/L was 100% specific for the presence of endothelial dysfunction (100% positive predictive value). There were 39 major adverse cardiovascular events during follow-up. In patients with normal endothelial function, hscTnI levels were significantly higher in patients who developed major adverse cardiac events when compared to patients who did not (1.35 ng/L [IQR, 1.1-2.1 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.02). CONCLUSION: Our findings suggest that endothelial dysfunction may be associated with higher baseline hscTnI levels, suggesting increased myocardial injury in this population of patients. Additional studies are necessary to further define the role of hscTnI in risk stratification in this population.

AB - BACKGROUND: Coronary endothelial dysfunction (CED) is associated with recurrent ischemia. The role of high-sensitivity cardiac troponin I (hscTnI) levels in patients with CED has not been established. METHODS: Patients with suspected ischemia, who underwent clinically indicated coronary angiography and were found to have non-obstructive coronary artery disease, were included in the study. CED was defined as ≤50% increase in coronary blood flow from baseline and/or a decrease in epicardial coronary artery diameter >20% in response to maximal dosages of acetylcholine. HscTnI was measured at the time of the procedure using the Architect hscTnI assay (Abbott). RESULTS: Of 299 patients, 60 had normal endothelial function and 239 patients had abnormal endothelial function. The median age of the population was 52 years (interquartile range [IQR], 45-60 years). Patients with abnormal endothelial function had significantly higher log hscTnI values when compared to patients with normal endothelial function (0.9 ng/L [IQR, 0.7-1.4 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.04). An hscTnI value >12.5 ng/L was 100% specific for the presence of endothelial dysfunction (100% positive predictive value). There were 39 major adverse cardiovascular events during follow-up. In patients with normal endothelial function, hscTnI levels were significantly higher in patients who developed major adverse cardiac events when compared to patients who did not (1.35 ng/L [IQR, 1.1-2.1 ng/L] vs 0.7 ng/L [IQR, 0.7-1.1 ng/L]; P≤.02). CONCLUSION: Our findings suggest that endothelial dysfunction may be associated with higher baseline hscTnI levels, suggesting increased myocardial injury in this population of patients. Additional studies are necessary to further define the role of hscTnI in risk stratification in this population.

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El Sabbagh A, Prasad M, Zack C, Widmer RJ, Karon BS, Lerman A et al. High-Sensitivity Troponin in Patients with Coronary Artery Endothelial Dysfunction. Journal of Invasive Cardiology. 2018 Nov 1;30(11):406-410.