Clinical InvestigationCoronary Artery DiseasePrevalence and prognostic significance of incidental cardiac troponin T elevation in ambulatory patients with stable coronary artery disease: Data from The Heart and Soul Study
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.
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2016, AtherosclerosisCitation Excerpt :However Troponin elevation also has prognostic relevance in patients without chestpain at rest. In ambulatory patients with established stable coronary artery disease (CAD) as enrolled in the Heart and Soul study, Troponin T (TnT) was detectable in 6% of the study population when using a conventional TnT assay [2]. With the recent introduction of the high-sensitivity Troponin T assay (hsTnT), circulating TnT levels could be detected in 81% of the same study population of ambulatory patients with stable CAD [3].
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2015, American Journal of MedicineCitation Excerpt :However, many patients present late after symptom onset, so it may be in this group that only an elevated value of cardiac troponin will be present.14 Whether we call this unstable angina or late non–ST-segment elevation myocardial infarction is semantic, because it is known that with high-sensitivity cardiac troponin, patients with “stable” disease who have elevated values are at an increased risk.19 The proper therapeutic approach to this subset remains unclear.
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