Basal and Ischemia-Induced Transcardiac Troponin Release into the Coronary Circulation in Patients with Suspected Coronary Artery Disease.docVIP

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Basal and Ischemia-Induced Transcardiac Troponin Release into the Coronary Circulation in Patients with Suspected Coronary Artery Disease.doc

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Basal and Ischemia-Induced Transcardiac Troponin Release into the Coronary Circulation in Patients with Suspected Coronary Artery Disease

BasalandIschemia-InducedTranscardiacTroponin ReleaseintotheCoronaryCirculationinPatientswith SuspectedCoronaryArteryDisease MasaakiKonishi1,2,SeigoSugiyama1*,KoichiSugamura1,ToshimitsuNozaki1,KeisukeOhba1, JunichiMatsubara1,KenjiSakamoto1,YasuhiroNagayoshi1,HitoshiSumida1,EiichiAkiyama1, YasushiMatsuzawa2,KentaroSakamaki3,SatoshiMorita3,KazuoKimura2,SatoshiUmemura4, HisaoOgawa1 1Departments of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan, 2Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan, 3Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama,Japan,4DepartmentofMedicalScienceandCardiorenalMedicine,YokohamaCityUniversityGraduateSchoolofMedicine,Yokohama,Japan Abstract Background:Cardiactroponinisaspecificbiomarkerforcardiomyocytenecrosisinacutecoronarysyndromes.Troponin releasefromthecoronarycirculationremainstobedeterminedbecauseofthelowersensitivityoftheconventionalassay. Wesoughttodeterminebasalandangina-inducedtroponinreleaseusingahighlysensitivetroponinassay. MethodsandResults:ThecardiactroponinTlevelsinserumsampledfromtheperipheralvein(PV),theaorticroot(AO), andthecoronarysinus(CS)weremeasuredin105consecutivestablepatientswithcoronaryriskfactor(s)andsuspected coronary artery disease (CAD) and in 33 patients without CAD who underwent an acetylcholine provocation test. At baseline, there was a significant increase in the troponin levels from AO [9.0 (6.4, 13.1) pg/mL for median (25th, 75th percentiles)]toCS[10.3(7.3,15.5)pg/mL,p,0.001]in96(91.4%)patientsandthedifferencewas1.1(0.4,2.1)pg/mL,which reflectedbasaltranscardiactroponinrelease(TTR).TTRwaspositivelycorrelatedwithPVlevels(r=0.22,p=0.03).Malesex, left ventricular hypertrophy determined by echocardiography, T-wave inversion, and CAD correlated with elevated TTR definedasabove:median,1.1pg/mL.AsignificantincreaseinTTRwasnotedin17patientswithcoronaryspasms