PMID- 26089013
OWN - NLM
STAT- MEDLINE
DCOM- 20151019
LR  - 20220317
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 116
IP  - 4
DP  - 2015 Aug 15
TI  - Usefulness of High-Sensitive Troponin Elevation After Effort Stress to Unveil 
      Vulnerable Myocardium in Patients With Heart Failure.
PG  - 567-72
LID - S0002-9149(15)01341-7 [pii]
LID - 10.1016/j.amjcard.2015.05.017 [doi]
AB  - Elevation of resting high-sensitivity troponin (hs-Tn) holds prognostic value in 
      heart failure (HF), but its pathophysiological meaning is unclear. We aimed to 
      investigate hs-Tn elevation after maximal exercise in patients with systolic HF 
      and its neurohormonal and hemodynamic correlates: 30 patients diagnosed with 
      systolic HF (left ventricular ejection fraction 32 +/- 8%, mean +/- SD), on 
      guideline-directed medical therapy and not recognized inducible ischemia, 
      underwent maximal cardiopulmonary stress test, with assay of plasma N-terminal 
      proB-type natriuretic peptide (NT-proBNP), norepinephrine (NE), and hs-TnT 
      (hs-TnT) at baseline, peak, and 1 and 4 hours after exercise. Cardiac output (CO) 
      was measured during effort, with a rebreathing technique. The natural logarithm 
      of the ratio between percentage (%) increase in CO and NT-proBNP 
      (ln[CO%/NT-proBNP% increase]) was evaluated, as a noninvasive estimate of 
      Frank-Starling adaptation to effort, with NT-proBNP variation considered as a 
      surrogate of end-diastolic left ventricular pressure variation. Hs-TnT increased 
      during exercise with a 4-hour peak (p = 0.001); 10 patients had hs-TnT increase 
      >20%. Patients with Hs-TnT increase >20% were more symptomatic at rest (p = 
      0.039) and showed greater NE at peak exercise (p = 0.003) and less 
      ln[CO%/NT-proBNP% increase] (p = 0.034). A lower ln[CO%/NT-proBNP% increase] 
      correlated with greater NE at peak exercise (r = -0.430, p = 0.018). In 
      conclusion, acute troponin elevation after maximal exercise was detected in 1/3 
      of this series. The association of troponin release with NE, CO, and NT-proBNP 
      changes after effort suggests a pathophysiological link among transient 
      hemodynamic overload, adrenergic activation, and myocardial cell damage, likely 
      identifying a clinical subset at greater risk for HF progression.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Pastormerlo, Luigi Emilio
AU  - Pastormerlo LE
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore 
      Sant'Anna, Pisa, Italy. Electronic address: pastormerlo@ftgm.it.
FAU - Agazio, Assunta
AU  - Agazio A
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy.
FAU - Benelli, Eleonora
AU  - Benelli E
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy.
FAU - Gabutti, Alessandra
AU  - Gabutti A
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy.
FAU - Poletti, Roberta
AU  - Poletti R
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy.
FAU - Prontera, Concetta
AU  - Prontera C
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy.
FAU - Clerico, Aldo
AU  - Clerico A
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore 
      Sant'Anna, Pisa, Italy.
FAU - Emdin, Michele
AU  - Emdin M
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore 
      Sant'Anna, Pisa, Italy.
FAU - Passino, Claudio
AU  - Passino C
AD  - Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio 
      CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore 
      Sant'Anna, Pisa, Italy.
LA  - eng
PT  - Journal Article
DEP - 20150521
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Peptide Fragments)
RN  - 0 (Troponin T)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - X4W3ENH1CV (Norepinephrine)
SB  - IM
MH  - Aged
MH  - Cardiac Output/physiology
MH  - Exercise/*physiology
MH  - Exercise Test
MH  - Female
MH  - Heart Failure/*blood/pathology/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Norepinephrine/blood
MH  - Peptide Fragments/blood
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Rest/physiology
MH  - Time Factors
MH  - Troponin T/*blood
MH  - Ventricular Function, Left/physiology
EDAT- 2015/06/20 06:00
MHDA- 2015/10/20 06:00
CRDT- 2015/06/20 06:00
PHST- 2015/03/23 00:00 [received]
PHST- 2015/05/14 00:00 [revised]
PHST- 2015/05/14 00:00 [accepted]
PHST- 2015/06/20 06:00 [entrez]
PHST- 2015/06/20 06:00 [pubmed]
PHST- 2015/10/20 06:00 [medline]
AID - S0002-9149(15)01341-7 [pii]
AID - 10.1016/j.amjcard.2015.05.017 [doi]
PST - ppublish
SO  - Am J Cardiol. 2015 Aug 15;116(4):567-72. doi: 10.1016/j.amjcard.2015.05.017. Epub 
      2015 May 21.