Introduction: Rising patterns of high-sensitivity cardiac troponin (hscTn) do not only occur during acute coronary syndrome, but also following cardiovascular stress. To improve our understanding about hscTn release associated with cardiovascular stress testing, we conducted a systematic review of the existing literature and performed a meta-analysis.
Methods: Two independent reviewers searched the literature for studies that reported hscTn change values (hscTnT or hscTnI) in relation to cardiac stress testing that were published between Jan 2008 and July 2016. Studies were excluded if they included patients with symptoms of myocardial ischemia prior to measurement of baseline hscTn value.
Results: This meta-analysis included 11 studies (n= 2,432) that reported hscTn before and after standard exercise or pharmacologic cardiac stress testing. After exercise stress testing, hscTnT increased by 1.1ng/L or 18% (8 studies, n=629) and hscTnI by 1.8ng/L or 72% (4 studies, n=831) in patients who did not develop inducible myocardial ischemia and by 0.5ng/L or 11% (6 studies, n=406) and hscTnI by 2.4ng/l or 41% (4 studies, n=365) in patients with inducible myocardial ischemia (Table 1). After pharmacological stress testing, hscTnT increased by 0.7ng/L or 11% (5 studies, n=443) and hscTnI by 1.7ng/L or 38% (2 studies, n=116) in patients who did not develop inducible myocardial ischemia and by -0.1ng/L or -0.4% (6 studies, n=251) and hscTnI by 2.4ng/l or 32% (2 studies, n=108) in patients with inducible myocardial ischemia (Table 1).
Conclusions: Results from this meta-analysis suggest that hscTn rising patterns after exercise and pharmacological stress testing appear inconsistent and comparably small.