Long-Term Prognostic Value of Novel Cardiac Biomarkers After Cardiac Stress Echocardiography (Testing)

Peter Nagele, M.D.

Project Overview:
Heart disease is one of the top killers among adults in the United States and in particular in the state of Missouri. Heart disease can present itself in different ways, from chest pain during exercise (“angina”) to the most dreaded complication of heart disease, acute heart attack and sudden death. Heart disease researchers have done an outstanding job over the course of the last decades to identify many risk factors for heart disease. Many initiatives and programs have been launched to prevent heart disease by modifying risk factors such as cholesterol, hypertension, and smoking. Nevertheless, while these programs have resulted in some spectacular successes, risk prediction for individual patients is still very difficult.

One method used to identify patients with heart disease and at high risk of future heart attacks is cardiac stress testing. Cardiac stress testing typically involves two aspects: “stress” which can either be exercise on a treadmill or a drug that causes stress to the heart, and secondly an imaging technique to study the heart. Typically cardiologists use ultrasound imaging for this purpose. Cardiac stress testing is widely used, but unfortunately has only moderate success in correctly identifying heart disease.

Recently, a new blood test has been developed (“high-sensitivity troponin”) that can measure a marker in the blood that is both extremely specific for heart damage but also exquisitely sensitive, allowing the detection even when no major heart attack is present. Several well done and large studies have shown that this novel marker can predict future heart attacks and deaths from heart disease.

In our study, we ask if using this new marker will improve the risk assessment when patients have a cardiac stress test. We plan to test 500 patients who are scheduled for cardiac stress testing at BJH and measure this marker before and after the stress test. We will then follow patients for 1 year and record who suffered a heart attack or death. We expect that using this new marker will improve the identification and risk assessment of patients with heart disease.