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High-sensitivity cardiac troponin T and copeptin assays to improve diagnostic accuracy of exercise stress test in patients with suspected coronary artery disease

Liebetrau, Christoph ; Gaede, Luise ; Dörr, Oliver ; Hoffmann, Jedrzej ; Wolter, Jan S. ; Weber, Michael ; Rolf, Andreas ; Hamm, Christian W. ; Nef, Holger M. ; Möllmann, Helge

Originalveröffentlichung: (2015) European Journal of Preventive Cardiology 22(6): 684–692; DOI: 10.1177/2047487314529691
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URN: urn:nbn:de:hebis:26-opus-124568

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Freie Schlagwörter (Englisch): coronary artery disease , cardiac troponin T , copeptin , exercise stress test , myocardial ischaemia
Sammlung: Allianz-/Nationallizenzen / Artikel
Universität Justus-Liebig-Universität Gießen
Institut: Division of Cardiology
Fachgebiet: Medizin
DDC-Sachgruppe: Medizin
Dokumentart: Aufsatz
Sprache: Englisch
Erstellungsjahr: 2015
Publikationsdatum: 25.01.2017
Kurzfassung auf Englisch: Background: The average diagnostic sensitivity of exercise stress tests (ESTs) is lower than that of other non-invasive cardiac stress tests. The aim of the study was to examine whether high-sensitivity cardiac troponin T (hs-cTnT) or copeptin concentrations rise in response to inducible myocardial ischaemia and may improve the diagnostic accuracy of ESTs.
Methods and results: An EST was performed stepwise on a bicycle ergometer by 383 consecutive patients with suspected or progression of coronary artery disease (CAD). In addition venous blood samples for measurement of hs-cTnT and copeptin were collected prior to EST, at peak exercise, and 4 h after EST. Coronary angiography was assessed for all patients. Patients with significant CAD (n=224) were more likely to be male and older compared to patients with non-significant CAD (n=169). Positive EST was documented in 125 (55.8%) patients with significant CAD and in 69 (43.4%) patients with non-significant CAD. Copeptin and hs-cTnT concentrations at baseline were higher in patients with significant CAD (copeptin: 10.8 pmol/l (interquartile range (IQR) 8.1–15.6) vs 9.4 pmol/l (IQR 7.1–13.9); p=0.04; hs-cTnT: 3.0 ng/l (IQR <3.0–5.4) vs <3.0 ng/l (IQR <3.0); p=0.006). Hs-cTnT improved sensitivity (61.6% vs 55.8%), specificity (67.7% vs 56.6%) and the positive predictive value (PPV) (72.3% vs 64.4%) and negative (55.2% vs 47.6%) predictive value (NPV) of EST. Copeptin could not improve sensitivity (55.4% vs 55.8%) and reduced specificity, PPV and NPV.
Conclusions: The measurement of hs-cTnT during EST improves sensitivity, specificity, and positive and negative predictive values. In contrast, measurement of copeptin does not improve diagnostic sensitivity and reduces specificity.
Lizenz: Allianz- / Nationallizenz