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Published on: January 28, 2020
Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with
C H Hansen1,2, J Cwikiel1, V Bratseth1,2
1Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.
Insights
Revascularization did not alter exercise-induced cardiac biomarker release in coronary artery disease patients. However, it reduced resting levels of endogenous thrombin potential and tissue factor pathway inhibitor, suggesting decreased thrombin generation.
Area of Science:
- Cardiology
- Biomarkers
- Vascular Biology
Background:
- Coronary artery disease (CAD) management often involves revascularization procedures.
- Cardiac biomarkers like cardiac Troponin T (cTnT) and NT-proBNP, along with prothrombotic markers, are crucial in assessing cardiac health and risk.
- The impact of revascularization on these biomarkers during exercise stress testing (EST) requires further elucidation.
Purpose of the Study:
- To investigate the effects of revascularization on resting and exercise-induced levels of cTnT, NT-proBNP, and prothrombotic markers in CAD patients.
- To determine if revascularization influences the release patterns of these biomarkers during an exercise ECG stress test (EST).
Main Methods:
- A cohort of 20 patients with confirmed CAD underwent two ESTs.
- The first EST (EST1) was performed before revascularization, and the second (EST2) nine weeks after revascularization.
- Blood samples were collected at rest and post-exercise for analysis of cTnT, NT-proBNP, D-dimer, pro-thrombin fragment 1+2, endogenous thrombin potential (ETP), and tissue factor pathway inhibitor (TFPI).
Main Results:
- Both cTnT and NT-proBNP levels increased significantly during exercise in both ESTs.
- Resting cTnT levels were higher at EST2 compared to EST1, while NT-proBNP levels did not differ.
- Exercise induced increases in D-dimer, pro-thrombin fragment 1+2, and TFPI were observed at both visits.
- Resting levels of ETP and TFPI were significantly reduced after revascularization.
Conclusions:
- Revascularization did not attenuate the exercise-induced release of cardiac and prothrombotic biomarkers.
- Resting levels of cTnT and NT-proBNP were not reduced by revascularization.
- The observed decrease in resting ETP and TFPI post-revascularization may indicate reduced thrombin generation and endothelial activation.
Abstract:
We examined whether resting levels and exercise-induced changes during exercise ECG stress test (EST) of cardiac Troponin T (cTnT), NT-proBNP and prothrombotic markers were affected by revascularization in patients with coronary artery disease (CAD).EST1 was performed before coronary angiography and revascularization, and patients (n = 20) with confirmed CAD, performed another EST (EST2) 9 weeks later. Blood samples were drawn at rest and within five min after termination of ESTs.cTnT and NT-proBNP increased during exercise at both ESTs (p < 0.001, all). Resting cTnT levels at EST2 versus EST1 were significantly higher (p = 0.02) whereas NT-proBNP did not differ. At both visits, increased D-dimer (p = 0.008 and <0.001), pro-thrombin fragment 1 + 2 (p = 0.009 and 0.001) and tissue factor pathway inhibitor (TFPI) (p < 0.001 and 0.001) during exercise were demonstrated. Resting levels of endogenous thrombin potential (ETP) and TFPI were reduced at EST2 versus EST1 (p < 0.01).Revascularization did not affect exercise-induced release of cardiac and prothrombotic biomarkers and did not reduce resting levels of cTnT or NT-proBNP, suggesting revascularization per se not to prevent secretion of biomarkers. The lower resting levels of ETP and TFPI after revascularization may however, be indicative of reduced thrombin generation and endothelial activation.Clinicaltrials.gov, CADENCE, NCT01495091 https://clinicaltrials.gov/ct2/show/NCT01495091?term = 01495091&draw = 2&rank = 1.
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