High‐Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke

Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high‐sensitivity cardiac troponin T (hs‐cTnT) are associated with recurrent vascular events and death in patients with first‐ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS‐B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs‐cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all‐cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs‐cTnT above upper reference limit, 39.2%). During a mean follow‐up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all‐cause death. The primary outcome occurred more often in patients with hs‐cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3–3.3), with a dose‐response relationship when the highest and lowest hs‐cTnT quartiles were compared (15.2 versus 1.8 events per 100 person‐years; adjusted hazard ratio, 4.8; 95% CI, 1.9–11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs‐cTnT is dose‐dependently associated with an increased risk of recurrent vascular events and death within 3 years after first‐ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs‐cTnT for individualized risk stratification after stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01363856.

Download Full-text

High-Sensitivity Cardiac Troponin T for Risk Stratification in Patients With Embolic Stroke of Undetermined Source

Stroke ◽

10.1161/strokeaha.120.029628 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2386-2394 ◽

Cited By ~ 2

Author(s):

Jan F. Scheitz ◽

Guillaume Pare ◽

Lesly A. Pearce ◽

Hardi Mundl ◽

W. Frank Peacock ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Stratification ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Embolic Stroke ◽

Cardiac Troponin T ◽

Reference Limit ◽

End Point ◽

Upper Reference Limit

Background and Purpose: Optimal secondary prevention for patients with embolic stroke of undetermined source (ESUS) remains unknown. We aimed to assess whether high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with major vascular events and whether hs-cTnT may identify patients who benefit from anticoagulation following ESUS. Methods: Data were obtained from the biomarker substudy of the NAVIGATE ESUS trial, a randomized controlled trial testing the efficacy of rivaroxaban versus aspirin for secondary stroke prevention in ESUS. Patients were dichotomized at the hs-cTnT upper reference limit (14 ng/L, Gen V, Roche Diagnostics). Cox proportional hazard models were computed to explore the association between hs-cTnT, the combined cardiovascular end point (recurrent stroke, myocardial infarction, systemic embolism, cardiovascular death), and recurrent ischemic stroke. Results: Among 1337 patients enrolled at 111 participating centers in 18 countries (mean age 67±9 years, 61% male), hs-cTnT was detectable in 95% and at/above the upper reference limit in 21%. During a median follow-up of 11 months, the combined cardiovascular end point occurred in 68 patients (5.0%/y, rivaroxaban 28 events, aspirin 40 events; hazard ratio, 0.67 [95% CI, 0.41–1.1]), and recurrent ischemic stroke occurred in 50 patients (4.0%/y, rivaroxaban 16 events, aspirin 34 events, hazard ratio 0.45 [95% CI, 0.25–0.81]). Annualized combined cardiovascular end point rates were 8.2% (9.5% rivaroxaban, 7.0% aspirin) for those above hs-cTnT upper reference limit and 4.8% (3.1% rivaroxaban, 6.6% aspirin) below with a significant treatment modification ( P =0.04). Annualized ischemic stroke rates were 4.7% above hs-cTnT upper reference limit and 3.9% below, with no suggestion of an interaction between hs-cTnT and treatment ( P =0.3). Conclusions: In patients with ESUS, hs-cTnT was associated with increased cardiovascular event rates. While fewer recurrent strokes occurred in patients receiving rivaroxaban, outcomes were not stratified by hs-cTn results. Our findings support using hs-cTnT for cardiovascular risk stratification but not for decision-making regarding anticoagulation therapy in patients with ESUS. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02313909.

Download Full-text

Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study

BMJ Open ◽

10.1136/bmjopen-2021-052004 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052004

Author(s):

Alexander Dietl ◽

Martina E Zimmermann ◽

Caroline Brandl ◽

Stefan Wallner ◽

Ralph Burkhardt ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Left Ventricular ◽

Cardiac Troponin T ◽

Cross Sectional ◽

Reference Limit ◽

Mobile Population ◽

Upper Reference Limit

ObjectiveEuropean guidelines recommended a uniform upper reference limit of high-sensitivity cardiac troponin T (hsTnT) to rule out non-ST segment elevation myocardial infarction. Our study aimed to provide a hsTnT reference distribution and to assess the specificity of the 14 ng/L cut-off value in the mobile population ≥70 years of age.DesignA cross-sectional analysis was performed in the German AugUR study (Altersbezogene Untersuchungen zur Gesundheit der University of Regensburg).SettingStudy population was the mobile population aged 70+ years living in the city and county of Regensburg, Germany.ParticipantsA random sample was derived from the local population registries of residence. Of the 5644 individuals invited, 1133 participated (response ratio=20.1%). All participants came to the study centre and were mentally and physically mobile to conduct the protocol (face-to-face interview, blood draw and standardised transthoracic echocardiography). None of the participants was in an acute state of myocardial infarction.ResultsAmong the 1129 individuals with hsTnT measurements (overall median=10.0 ng/L(25th, 75th percentile)=(7.0, 15.0 ng/L)), hsTnT was higher among the older individuals and higher among men (men 70–74 years median=9.6 ng/L (7.2, 13.1 ng/L); men 90–95 years median=21.2 ng/L (14.6, 26.0 ng/L); women 70–74 years median=6.3 ng/L (4.7, 8.7 ng/L); and women 90–95 years median=18.0 ng/L (11.0, 21.0 ng/L)). In participants with impaired kidney function (eGFRcrea <60 mL/min/1.73 m2), hsTnT was elevated (median=13.6 ng/L (9.4, 20.6 ng/L)).Specificity of recommended upper reference limit, 14 ng/L, is 68%. Most false positives were among men aged >79 years (specificity=34%). In a healthy subgroup (n=96, none of the following: overt heart disease, impaired renal function, blood pressure >160/100 mm Hg, left ventricular hypertrophy and diastolic/systolic dysfunction), specificity was 90%.ConclusionIn the elderly population without acute myocardial infarction, hsTnT further increases with age showing different levels for men and women. The specificity of the 14 ng/L cut-off is considerably lower than 99%, even in healthy subjects.

Download Full-text

Prognostic value of elevated high-sensitivity cardiac troponin T in acute ischemic stroke patients treated with endovascular thrombectomy in late time windows

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106921 ◽

2021 ◽

pp. 106921

Author(s):

Yi Wu ◽

Yue-Zhou Cao ◽

Lin-Bo Zhao ◽

Zhen-Yu Jia ◽

Sheng Liu ◽

...

Keyword(s):

Ischemic Stroke ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin T ◽

Time Windows ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Late Time ◽

Stroke Patients ◽

Endovascular Thrombectomy

Download Full-text

Letter by Xu et al Regarding Article, “High-Sensitivity Cardiac Troponin T and Cognitive Function in Patients With Ischemic Stroke”

Stroke ◽

10.1161/strokeaha.120.030451 ◽

2020 ◽

Vol 51 (8) ◽

Author(s):

Zongliang Xu ◽

Gelin Xu ◽

Junrong Li

Keyword(s):

Ischemic Stroke ◽

Cognitive Function ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T

Download Full-text

High-sensitivity cardiac troponin T and severity of cerebral white matter lesions in patients with acute ischemic stroke

Journal of Neurology ◽

10.1007/s00415-018-9085-3 ◽

2018 ◽

Vol 266 (1) ◽

pp. 37-45 ◽

Cited By ~ 6

Author(s):

Regina von Rennenberg ◽

Bob Siegerink ◽

Ramanan Ganeshan ◽

Kersten Villringer ◽

Wolfram Doehner ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Acute Ischemic Stroke ◽

Cardiac Troponin ◽

Troponin T ◽

White Matter Lesions ◽

High Sensitivity ◽

Cerebral White Matter ◽

Cardiac Troponin T ◽

Cerebral White Matter Lesions

Download Full-text

The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States

Clinica Chimica Acta ◽

10.1016/j.cca.2020.01.027 ◽

2020 ◽

Vol 504 ◽

pp. 172-179

Author(s):

Robert L. Fitzgerald ◽

Judd E. Hollander ◽

W. Frank Peacock ◽

Alexander T. Limkakeng ◽

Nancy Breitenbeck ◽

...

Keyword(s):

United States ◽

Cardiac Troponin ◽

Troponin T ◽

The United States ◽

Cardiac Troponin T ◽

Reference Limit ◽

Upper Reference Limit

Download Full-text

Preoperative cardiac troponin below the 99th-percentile upper reference limit and 30-day mortality after noncardiac surgery

Scientific Reports ◽

10.1038/s41598-020-72853-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Jungchan Park ◽

Cheol Won Hyeon ◽

Seung-Hwa Lee ◽

Sangmin Maria Lee ◽

Junghyun Yeo ◽

...

Keyword(s):

Cardiac Troponin ◽

Primary Outcome ◽

Multivariate Analyses ◽

Limit Of Detection ◽

High Sensitivity ◽

Noncardiac Surgery ◽

Surgical Patients ◽

Reference Limit ◽

Risk Of Mortality ◽

Upper Reference Limit

Abstract Preoperative high-sensitivity cardiac troponin (hs-cTn) above the 99th-percentile upper reference limit (URL) is associated with mortality after noncardiac surgery. This study aimed to evaluate whether preoperative hs-cTn concentrations above the lowest limit of detection (LOD) but below the 99th-percentile URL can predict mortality after noncardiac surgery.From January 2010 to April 2019, a total of 12,415 noncardiac surgical patients with preoperative hs-cTn I below the 99th-percentile URL were enrolled. The patients were divided into two groups according to preoperative hs-cTn I concentration: (1) [hs-cTn] below the LOD (6 ng/L), and (2) mildly elevated [hs-cTn] but below the 99th-percentile URL (40 ng/L). The primary outcome was 30-day mortality. Of the 12,415 patients enrolled, 7958 (64.1%) were in the LOD group whereas 4457 (35.9%) were in the mild elevation group. The incidence of 30-day mortality was significantly greater in the mild elevation group (2.1% vs. 4.0% hazard ratio [HR] 1.73; 95% confidence interval [CI] 1.39–2.16; p < 0.001) in the multivariate analyses. The propensity score matched analyses also produced a similar result (2.6% vs. 4.2% HR 1.61; 95% CI 1.26–2.07; p < 0.001). The threshold at which the risk of mortality increased corresponded to a preoperative hs-cTn I ≥ 12 ng/L. Patients with preoperative hs-cTn I above the LOD and below the 99th-percentile URL had greater 30-day mortality after noncardiac surgery.

Download Full-text