• Antonio De Vita, Isabella Bruno, Silvia Baroni, Giacomo Moretti, Federica Tempestini, Alessandro Telesca, Saverio Tremamunno, Tamara Felici, Alfonso Verrillo, Valeria Tempesta, Vanessa Feudo, Priscilla Lamendola, Giovanna Liuzzo, Filippo Crea, Alessandro Giordano, and Gaetano Antonio Lanza.
• Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8 - 00168, Rome, Italy; Department of Cardiovascular and Pneumologic Sciences, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: antonio.devita@guest.policlinicogemelli.it.
• Eur. J. Intern. Med. 2024 May 1; 123: 107113107-113.

BackgroundPrevious studies showed that exercise may increase cardiac troponin serum levels; whether the occurrence of myocardial ischemia influences the changes of exercise-induced troponin raise, however, remains debatable.MethodsWe prospectively enrolled consecutive patients undergoing for the first time an elective stress myocardial perfusion scintigraphy (MPS) because of clinical suspicion of obstructive coronary artery disease (CAD). Patients were divided into 3 groups based on the evidence and degree of stress-induced myocardial ischemia at MPS: 1) group 1, no myocardial ischemia (≤4 %); 2) group 2, mild myocardial ischemia (5-10 %); 3) group 3, moderate-to-severe myocardial ischemia (≥10 %). High-sensitivity cardiac troponin I (cTnI) was measured immediately before (T0) and 1 hour (T1) and 4 h (T2) after the stress test.ResultsOne hundred-seven patients (71 males; age 65.6 ± 9.4 years) were enrolled in the study. Serum hs-cTnI concentrations (logarithmic values) significantly increased after MPS, compared to baseline, in the whole population, from 1.47±1.26 ng/L at T0, to 1.68±1.12 ng/L at T1 (p<0.001) and 2.15±1.02 ng/L at T2 (p<0.001 vs. both T0 and T1). The increase in hs-cTnI did not significantly differ between the 3 groups (p = 0.44). The heart rate achieved during the test was the strongest determinant of cTnI increase (p < 0.001) after the stress test.ConclusionsIn patients with suspected CAD, stress MPS induces an increase of cTnI that is independent of the induction and extension/severity of myocardial ischemia and is mainly related to myocardial work, as indicated by the heart rate achieved during the test.Copyright © 2023. Published by Elsevier B.V.

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