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Eur J Prev Cardiol. 2015 Jun;22(6):684-92. doi: 10.1177/2047487314529691. Epub 2014 Apr 3.

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

Author information

1
Department of Cardiology, Kerckhoff Heart and Thorax Centre, Germany c.liebetrau@kerckhoff-klinik.de.
2
Department of Cardiology, Kerckhoff Heart and Thorax Centre, Germany.
3
Division of Cardiology, Justus Liebig University Giessen, Germany.

Abstract

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.

KEYWORDS:

Coronary artery disease; cardiac troponin T; copeptin; exercise stress test; myocardial ischaemia

PMID:
24699335
DOI:
10.1177/2047487314529691
[Indexed for MEDLINE]

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