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Eur Heart J. 2009 Jan;30(2):162-9. doi: 10.1093/eurheartj/ehn504. Epub 2008 Nov 8.

Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35.

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  • 1TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.



To determine whether an ultrasensitive assay can permit quantification of changes in circulating cardiac troponin (Tn) in the setting of stress test-induced myocardial ischaemia.


Blood samples were obtained before, immediately after, and 2 and 4 h after stress testing with nuclear perfusion imaging in 120 patients. Troponin was measured using commercial assays as well as with a novel, ultrasensitive cardiac TnI assay with a limit of detection of 0.2 pg/mL. Using the ultrasensitive assay, TnI was detectable in all patients before stress testing (median 4.4 pg/mL, interquartile range 3.1-8.6 pg/mL). By 4 h, troponin levels were unchanged in patients without ischaemia, whereas circulating levels had increased by a median of 1.4 pg/mL (24% increase) in patients with mild ischaemia (P = 0.002) and by 2.1 pg/mL (40% increase) in patients with moderate-to-severe ischaemia (P = 0.0006). In contrast, changes in troponin levels across patients in different ischaemic categories were indistinguishable using commercial troponin assays. When added to clinical factors, a >1.3 pg/mL increase in TnI using the ultrasensitive assay was an independent predictor of ischaemia (odds ratio 3.54, P = 0.007).


Transient stress test-induced myocardial ischaemia is associated with a quantifiable increase in circulating troponin that is detectable with a novel, ultrasensitive TnI assay.

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