Determinants of minimal elevation in high-sensitivity cardiac troponin T in the general population

Background: High-sensitivity cardiac troponin T (TnT) is a potent predictor of cardiovascular disease (CVD) in the general population. Recently, the US FDA has approved Roche fifth generation (Gen 5) TnT assay (more sensitive than the fourth generation [Gen 4] TnT assay). Since many previous epidemiological studies used Gen 4 TnT, it is important to characterize the association of Gen 5 TnT with major CVD events. Methods: We first assessed correlation of Gen 5 vs. Gen 4 TnT in a subsample of 91 participants. Then, as the main analysis, we examined the association of Gen 5 TnT at visit 3 (1993-1995) with major CVD events (coronary heart disease [CHD], stroke, heart failure [HF], and peripheral artery disease [PAD]). Gen 5 TnT was categorized as <6 (limit of quantification), 6-<8, 8-<14, 14-<19, and ≥19 ng/L. CHD and stroke events were adjudicated whereas HF and PAD were based on hospitalization codes. We also conducted a subgroup analysis by prevalent CVD at baseline. Results: Gen 5 TnT and Gen 4 TnT had a correlation coefficient of 0.98 (0.88 after excluding outliers >3SD). Of 11,979 participants (mean age 60 [SD 6] years, 1,840 [15%] with prevalent CVD), 5,856 (49%) participants had quantifiable levels of TnT. During a median follow-up of 22.1 years, there were 1,850 CHD events, 1,075 stroke events, 2,908 HF cases, and 571 PAD cases. Gen 5 TnT showed a robust dose response association with each CVD type, with adjusted hazard ratio 2-4 for TnT ≥19 (vs.<6) ng/L ( Table ). Even the category 6-<8 ng/L showed significantly elevated risk for all outcomes except stroke. The associations were stronger for HF and PAD than CHD or stroke (all p-values using seemingly unrelated regression <0.001). The associations were similar regardless of baseline CVD status. Conclusions: Gen 5 TnT was highly correlated with Gen 4 TnT and gave quantifiable values in half middle-aged adults. Gen 5 TnT was robustly associated with major CVD events (especially HF and PAD) in the general population, supporting its usefulness in epidemiological research and clinical practice.

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1461-P: Cardiac Troponin T and Troponin I and Incident Diabetes in the General Population: Generation Scotland Scottish Family Health Study

Diabetes ◽

10.2337/db19-1461-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1461-P

Author(s):

PAUL WELSH ◽

DAVID PREISS ◽

ARCHIE CAMPBELL ◽

DAVID J. PORTEOUS ◽

NICHOLAS L. MILLS ◽

...

Keyword(s):

General Population ◽

Cardiac Troponin ◽

Troponin I ◽

Troponin T ◽

Family Health ◽

Incident Diabetes ◽

Health Study ◽

Cardiac Troponin T ◽

Generation Scotland

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Impact of high‐sensitivity cardiac troponin T on survival and rehospitalization after transcatheter aortic valve replacement

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29781 ◽

2021 ◽

Author(s):

Simon Schoechlin ◽

Undine Schulz ◽

Philip Ruile ◽

Manuel Hein ◽

Martin Eichenlaub ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Cardiac Troponin ◽

Transcatheter Aortic Valve Replacement ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Transcatheter Aortic Valve

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Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-0367 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Chen Dongxu ◽

Zhou Yannan ◽

Yang Yilin ◽

Yao Chenling ◽

Gu Guorong ◽

...

Keyword(s):

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Chinese Han ◽

Han Population ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Rule Out

Abstract Objectives A rapid 0 h/1 h algorithm using high-sensitivity cardiac troponin T (hs-cTnT) for rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) is recommended by the European Society of Cardiology. We aim to prospectively evaluate the diagnostic performance of the algorithm in Chinese Han patients with suspected NSTEMI. Methods In this prospective diagnostic cohort study, 577 patients presenting to the emergency department with suspected NSTEMI and recent (<12 h) onset of symptoms were enrolled. The levels of serum hs-cTnT were measured on admission, 1 h later and 4–14 h later. All patients underwent the initial clinical assessment and were triaged into three groups (rule-out, rule-in and observe) according to the 0 h/1 h algorithm. The major cardiovascular events (MACE) were evaluated at the 7-day and 30-day follow-ups. Results Among 577 enrolled patients, NSTEMI was the final diagnosis for 106 (18.4%) patients. Based on the hs-cTnT 0 h/1 h algorithm, 148 patients (25.6%) were classified as rule-out, 278 patients (48.2%) as rule-in and 151 patients (26.2%) were assigned to the observe group. The rule-out approach resulted in a sensitivity of 100% and negative predictive value of 100%. The rule-in approach resulted in a specificity of 62.9% [95% CI (58.5–67.2%)] and positive predictive value of 37.1% [95%CI (31.3–42.8%)]. No MACE was observed in the rule-out group within 30-day follow-up. Conclusions The hs-cTnT 0 h/1 h algorithm is a safe tool for early rule-out of NSTEMI, while probably not an effective strategy for accurate rule-in of NSTEMI in Chinese Han population.

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