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High sensitivity troponin detects subclinical cardiovascular disease

4 Jan, 11 | by Alistair Lindsay

Although most commonly used in the setting of acute coronary syndromes, it is also recognised that elevated troponin levels are seen in other clinical scenarios such as chronic kidney disease, heart failure, and chronic kidney disease.  Troponin T (TnT) is occasionally detectable in individuals from the general population, and although this has been associated with an increased risk of death and adverse cardiovascular events, the low prevalence of detection with current assays would prevent its widespread application.  This study examined the use of a new high-sensitivity assay to predict mortality in the general population.

3546 individuals enrolled in the Dallas Heart Study between 2000 and 2002 were recruited.  Participants were stratified into five categories based on TnT levels.  The prevalence of detectable TnT (≥0.003 ng/mL) was 25.0% with the highly sensitive assay vs. 0.7% with the standard assay, and higher levels were noted in men and in more elderly patients.  Higher TnT levels were also associated with left ventricular hypertrophy, left ventricular systolic dysfunction, and chronic kidney disease.  Median follow-up was 6.4 years, during which there were 151 deaths of which 62 were cardiovascular.  All cause mortality increased from 1.9% to 28.4% across higher TnT categories (P<.001).

Conclusions

A new, highly-sensitive, cardiac troponin T assay was associated with structural heart disease and all cause mortality in this community study.  New assays are expanding the diagnostic role of troponin T to include chronic, as well as acute, cardiovascular disease.

  • de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010; 304:2503-2512.
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