Elsevier

American Heart Journal

Volume 158, Issue 4, October 2009, Pages 673-679
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Prevalence and prognostic significance of incidental cardiac troponin T elevation in ambulatory patients with stable coronary artery disease: Data from The Heart and Soul Study

https://doi.org/10.1016/j.ahj.2009.07.021Get rights and content

Background

The significance of troponin elevation and clinical utility of troponin testing in ambulatory patients with coronary artery disease (CAD) have not been examined. We sought to investigate the prevalence and prognostic value of cardiac troponin T (cTnT) elevation in a population with stable CAD.

Methods

We studied 987 patients with stable CAD enrolled in the Heart & Soul study who had plasma cTnT measurements before performing exercise treadmill testing.

Results

Of the studied population, 58 patients or 6.2% had detectable cTnT levels, ≥0.01 ng/mL (0.01-0.72 ng/mL). During a mean follow-up period of 4.3 (0.1-6.5) years, 58.6% of participants with detectable cTnT had cardiovascular events compared with 22.5% of those without detectable cTnT (hazard ratio [HR] 3.8, 95% CI 2.6-5.4, P < .001). This association remained strong after adjustment for traditional risk factors and C-reactive protein (HR 2.0, 95% CI 1.3-3.1, P = .002). However, after further adjustment for N-terminal pro–B-type natriuretic peptide and echocardiographic parameters of left ventricular function, cTnT elevation was not an independent predictor of cardiovascular events (HR 1.3, 95% CI, 0.8-2.3, P = .28).

Conclusions

In ambulatory patients with stable CAD, the prevalence of cTnT elevation was 6.2%. Cardiac troponin T elevation detected using the conventional troponin assay was associated with increased risk of adverse cardiovascular outcomes, but its prognostic value was not incremental over N-terminal pro–B-type natriuretic peptide and echocardiographic evidence of cardiac abnormalities.

Section snippets

Participants

The Heart and Soul Study is a prospective cohort study designed to investigate the prognostic impact of psychosocial factors on patients with CAD. Methods have been described previously.8 Participants were recruited from 2 Veterans Affairs Medical Centers (San Francisco and Palo Alto), 1 university-based medical center (University of California, San Francisco), and 9 public health clinics in San Francisco, CA. One of the following criteria must be met to be eligible for study enrollment: (1)

Results

We found that in our study population of patients with stable CAD, the prevalence of any cTnT elevation was 6.2% (58/987). The level of elevation ranged from 0.01 to 0.72 ng/mL (Figure 1). Among the patients with cTnT elevation, 23 patients, or 2.3%, of all studied patients had levels >0.03 ng/mL. The cTnT levels for the remaining 35 patients, or 3.5%, of the studied population of 987 were between 0.01 and 0.03 ng/mL. Of the 987 study participants, 978 (>99%) were followed for a mean of 4.3

Discussion

In an ambulatory population of patients with stable CAD, we found that the prevalence of cTnT elevation was 6.2%. Detectable cTnT was associated with an increased risk of cardiovascular events, independent of creatinine, traditional cardiovascular risk factors, and CRP. However, the predictive value of cTnT elevation was not independent of NT-proBNP or echocardiographic measures of cardiac structure and function.

Conclusions

We found that the prevalence of cTnT elevation in an ambulatory population with stable CAD was 6.2%. Cardiac troponin T elevation predicted adverse cardiovascular outcomes, independent of traditional risk factors and CRP. However, the association between cTnT and cardiovascular events was explained by other measures of cardiac functional and structural abnormalities. Therefore, routine cTnT testing does not provide incremental prognostic value over other clinical and biochemical biomarkers.

References (19)

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