Association between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease

Otsuka, Toshiaki; Kawada, Tomoyuki; Ibuki, Chikao; Seino, Yoshihiko

doi:10.1016/j.ahj.2010.02.036

Cited by 90 publications

(76 citation statements)

References 25 publications

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“…Categorical variables are presented as proportions and continuous variables as mean (SD) or median (quartiles [1][2][3]. In view of the markedly skewed distribution of hs-cTnT, changes in concentrations over time were calculated as the difference between the natural logarithm of the concentrations at follow-up and at baseline.…”

Section: Methodsmentioning

confidence: 99%

“…Increases in hs-cTnT concentrations were associated with all-cause mortality (incidence rates, 8.19 [7.51-8.88 Key Words: biomarkers Ⅲ heart failure Ⅲ natriuretic peptides Ⅲ prognosis Ⅲ troponin T V ery low circulating levels of troponin are detectable in the general population with the new generation of highly sensitive assays and are associated with adverse cardiovascular outcomes. [1][2][3] Besides acute myocardial infarction, elevated troponin levels are also reported in several chronic disease states like coronary artery disease, 4,5 diabetes mellitus, 6 or chronic kidney disease. 7 Troponin release in the bloodstream is low in patients with stable chronic heart failure (HF) and predicts adverse outcomes.…”

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confidence: 99%

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Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

et al. 2012

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on behalf of the Valsartan Heart Failure Trial (Val-HeFT) and Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) InvestigatorsBackground-Cardiac troponins are emerging as important prognostic markers in chronic cardiovascular conditions like stable coronary artery disease or chronic heart failure (HF). Less is known about the relation between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) and future events in HF. We determined the association between changes over time in hs-cTnT and outcome in patients with chronic HF. Methods and Results-We analyzed 5284 patients with chronic HF from 2 independent randomized clinical trials, the Valsartan Heart Failure Trial (Val-HeFT) (nϭ4053) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial (nϭ1231). hs-cTnT was measured at randomization and after 3 months (GISSI-HF) or 4 months of follow-up (Val-HeFT). The association between changes over time of hs-cTnT and various outcomes was tested in multivariable models. In both studies, increases in hs-cTnT levels over time were associated with age, diabetes mellitus, worsening of renal function (reduction in estimated glomerular filtration rate), and baseline and increases in N-terminal pro-brain natriuretic peptide concentrations. Increases in hs-cTnT concentrations were associated with all-cause mortality (incidence rates, 8.19 [7.51-8.88 Key Words: biomarkers Ⅲ heart failure Ⅲ natriuretic peptides Ⅲ prognosis Ⅲ troponin T V ery low circulating levels of troponin are detectable in the general population with the new generation of highly sensitive assays and are associated with adverse cardiovascular outcomes. [1][2][3] Besides acute myocardial infarction, elevated troponin levels are also reported in several chronic disease states like coronary artery disease, 4,5 diabetes mellitus, 6 or chronic kidney disease. 7 Troponin release in the bloodstream is low in patients with stable chronic heart failure (HF) and predicts adverse outcomes. 8,9 The mechanisms of troponin release in chronic HF are not entirely clear and not only may reflect ongoing cardiac myocyte damage but also may be related to noncardiac causes such as pulmonary disease or chronic renal insufficiency that are not infrequent comorbidities in HF. 10,11 Received May 24, 2011; accepted November 18, 2011 Clinical Perspective on p 288The increased sensitivity of the newly developed assays for cardiac troponins comes at the cost of decreased specificity, making clinical judgment more important in the interpretation of troponin assay results. 12 Although baseline high-sensitivity cardiac troponin T (hs-cTnT) levels are strong predictors of adverse outcome, a few studies suggest that changes in hs-cTnT levels over time may convey additional prognostic information compared with a single measurement. 2 In this report, we present the results from 2 large multicenter randomized clinical trials (Valsartan Heart Failure Trial [Val-HeFT] and...

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

et al. 2012

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“…Recent studies have shown that the high sensitivity cTnT assay has a prognostic value at concentrations that are undetectable using the conventional cTnT assay in patients with chronic heart failure 6) and was significantly associated with the incidence of cardio-vascular death and heart failure in patients with stable coronary artery disease. 34) Otsuka, et al 35) reported that high sensitivity cTnT was independently associated with systolic BP and LV hypertrophy in middle-aged men without overt cardiovascular disease. Thus, high sensitivity cTnT might be elevated and have a prognostic value at undetectable levels of the conventional cTnT in hypertensive patients.…”

Section: Therapeutic Implications Of Ongoing Myocardial Damage In Hy-mentioning

confidence: 99%

Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

et al. 2011

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SummaryOngoing myocardial damage detected as elevated serum cardiac troponin T (cTnT) indicates increased risk for future cardiac events in patients with chronic heart failure. Whether elevated cTnT is associated with adverse outcomes in patients with hypertension (HT) without left ventricular (LV) systolic dysfunction is unknown.We measured cTnT levels in 176 patients with essential HT without LV systolic dysfunction (LV ejection fraction ≤ 55%), renal failure, and prior cardiovascular or cerebrovascular diseases and 39 normal controls. Levels of cTnT were elevated ( ≥ 0.02 ng/mL) in 15 (9%) of the 176 patients and in 0 (0%) of the 39 normal controls (P = 0.04). The rate of diabetes mellitus (DM), the cardiothoracic ratio, plasma B-type natriuretic peptide (BNP) value, and LV mass index were significantly higher in patients with than without elevated cTnT (DM, 8/15 versus 29/161, P = 0.004; cardiothoracic ratio, 54.5 ± 4.5 versus 51.6 ± 5.2%, P = 0.04; BNP, 103.3 ± 142.3 versus 36.9 ± 50.7 pg/mL, P = 0.04; LV mass index, 227 ± 87 versus 152 ± 57 g/m 2 , P = 0.0001). Kaplan-Meier analysis demonstrated that significantly fewer (P < 0.000001) patients with, than without elevated cTnT remained free of events (hospitalization due to cardiovascular or cerebrovascular disease, n = 34). Stepwise Cox multivariate analysis revealed that elevated cTnT (hazard ratio, 6.58; P = 0.000001) and smoking (hazard ratio, 2.24; P = 0.04) were independent predictors of events.The present findings indicate that cTnT is a novel and useful predictor of future cardiovascular or cerebrovascular events in hypertensive patients. (Int Heart J 2011; 52: 164-169)

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“…3. Levels of cTn as measured with the new, high-sensitivity assays are associated with elevated cardiovascular risk in apparently healthy, middle aged men (30). Few study subjects in this cohort display cTn levels above the recommended new cutpoint for the diagnosis of acute MI (30).…”

Section: Cardiac Troponins: Presentmentioning

confidence: 99%

“…cTn assays, which are able to measure circulating cTn levels in more than 50% of a normal reference population, have been suggested to be called ''high-sensitive'' cTn assays (29). In the meantime, cTn levels can even be measured in )80% of healthy people with a coefficient of variation -10% at the recommended cutpoint (18,30). High-sensitivity assays are 1000-10,000-fold more sensitive than the original first generation assays due to improvement of epitope selection of antibodies and innovative capture and detection techniques (1).…”

Section: Cardiac Troponins: Presentmentioning

confidence: 99%

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Christ

Bertsch

Popp

et al. 2011

Clinical Chemistry and Laboratory Medicine (CCLM)

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Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.

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Association between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease

Cited by 90 publications

References 25 publications

Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

Elevated Cardiac Troponin T Predicts Adverse Outcomes in Hypertensive Patients

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

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