Association of Troponin T Detected With a Highly Sensitive Assay and Cardiac Structure and Mortality Risk in the General Population

By J. D. de Lemos, M. Drazner, T. Omland, C. Ayers, A. Khera, Anand Rohatgi, I. Hashim, J. Berry, Sandeep R. Das, D. A. Morrow and 1 more. Journal of the American Medical Association (JAMA), 2010

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Context Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. Objectives To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Design, Setting, and Participants Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Main Outcome Measures Magnetic resonance imaging measurements of cardiac structure and function and mortality through a median of 6.4 (interquartile range, 6.0–6.8) years of follow-up. Results In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%−27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%−1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%−41.0%) in men vs 12.9% (95%CI,10.6%−15.2%) in women and 14.0% (95% CI, 11.2%−16.9%) in participants younger than 40 years vs 57.6% (95% CI,47.0%−68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%−8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%−59.6%) in the highest (≥0.014 ng/mL) (P < .001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P < .001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%−2.6%) to 28.4% (95% CI, 21.0%−37.8%) across higher cTnT categories (P < .001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4–5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P = .02) and the integrated discrimination index (0.010 [95% CI, 0.002–0.018]; P = .01). Conclusion In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/66c1f5d2978bdc0cbf4b9776faa2796c54e4689b

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