Vaz Humberto Andres, Vanz Ana Paula, Castro Iran
Fundação Universitária de Cardiologia, Instituto de Cardiologia, Porto Alegre, RS, Brazil.
Arq Bras Cardiol. 2016 Apr;106(4):304-10. doi: 10.5935/abc.20160029. Epub 2016 Mar 8.
The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities.
To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia.
Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT0h), 2 (TnT2h), 5 (TnT5h), and 8 hours (TnT8h) after ET. The outcomes were peak hscTnT, TnT5h/TnT0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance).
This study included 95 patients. The highest geometric means were observed at 5 hours (TnT5h). After adjustments, peak hscTnT, TnT5h/TnT0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests.
Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.
应在不同情况下研究高敏肌钙蛋白T（hscTnT）的释放动力学，包括伴有短暂性缺血异常的功能测试。
通过运动试验（ET）后的系列测量评估hscTnT的释放，并将hscTnT升高与提示缺血的异常情况相关联。
接受直接血管成形术的急性ST段抬高型心肌梗死（STEMI）患者在梗死后3个月接受ET检查。在ET前（TnT0h）、ET后2小时（TnT2h）、5小时（TnT5h）和8小时（TnT8h）采集血样以测量基础hscTnT。观察指标为hscTnT峰值、TnT5h/TnT0h比值以及hscTnT水平的血药浓度-时间曲线下面积（AUC）。对hscTnT值进行对数转换，采用几何平均比值及其95%置信区间进行比较评估。通过未校正的协方差分析评估统计学意义，然后校正TnT0h、年龄和性别，随后校正其他变量（代谢当量、达到的最大心率、前壁STEMI和肌酐清除率）。
本研究纳入95例患者。在5小时（TnT5h）观察到最高几何均值。校正后，与测试正常的患者相比，ET异常的患者hscTnT峰值、TnT5h/TnT0h和AUC分别高出59%（p = 0.002）、59%（p = 0.003）和45%（p = 0.003）。
与正常ET相比，STEMI患者异常ET后hscTnT升高可能更高。
