High-Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure

Abstract

BACKGROUND Although small elevations of high sensitive cardiac troponin T (hs-cTnT) are associated with incident heart failure (HF) in the general population, the underlying mechanisms are not well defined. Evaluating the association of hs-cTnT with replacement fibrosis and progression of structural heart disease prior to symptoms is fundamental to understanding the potential of this biomarker in a HF prevention strategy. METHODS We measured hs-cTnT at baseline among 4,986 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort initially free of overt cardiovascular disease (CVD). Cardiac magnetic resonance (CMR) imaging was performed at baseline. Repeat CMR was performed 10 years later among 2,831 participants who remained free of interim CVD events; of these 1,723 received gadolinium-enhanced CMR for characterization of replacement fibrosis by late gadolinium enhancement (LGE). Progression of subclinical CVD was defined by 10-year change in left ventricular structure and function. Associations of hs-cTnT with incident HF, CV-related mortality, and coronary heart disease were estimated using Cox regression models. RESULTS LGE for replacement fibrosis was detectable in 6.3% participants without interim CVD events by follow-up CMR. A graded association was observed between higher baseline hs-cTnT categories and LGE (≥7.42 ng/L vs <limit of detection [LOD: < 3 ng/L], adjusted odds ratio [OR]=2.87, 95% CI: 1.38, 5.94). Higher hs-cTnT was also associated with a greater probability of an increase in LV mass >12% (highest category vs <LOD), OR=1.50, 95% confidence interval [CI]:1.09–2.07), but not with decline in LV ejection fraction. The risk of incident HF was greater for higher hs-cTnT (≥8.81 ng/L vs <LOD, adjusted hazards ratio [HR] 5.59, 95%CI, 2.97 – 10.68). CONCLUSIONS hs-cTnT levels are associated with replacement fibrosis and progressive changes in LV structure in CVD free adults, findings that may precede HF symptoms by years. Minor elevations of hs-cTnT may represent a biochemical signature of early subclinical cardiac disease, providing an opportunity for targeted preventive interventions.

High-sensitive troponin is associated with subclinical imaging biosignature of inflammatory cardiovascular involvement in systemic lupus erythematosus

“…The significantly and prevalently raised troponin levels in patients with SLE provide a sensitive validation of the subclinical myocardial injury 26. We and others have previously shown raised troponin levels in clinically manifest lupus myocarditis (10,16,52-54).…”

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

“…hs-cTnT and NT-proBNP were measured in EDTA plasma previously unthawed or unthawed once that was collected at baseline in the MESA cohort (2000)(2001)(2002) and measured as previously described on the Cobas e601 (Roche Diagnostics, Indianapolis, IN). 6 NT-proBNP was measured in a total of 6791 (99.6%) and hs-cTnT in 6783 (99.5%) participants.…”

What are normal high-sensitivity troponin-T values in a large multi-ethnic Asian population?

“…We have not assessed the diagnostic efficiency of this hs-TnT assay in clinical situations such as chest pain, chronic kidney disease, diabetes or community screening. However, this assay has been widely studied with favorable performance in several clinical studies -diagnosis of acute myocardial infarction [28], early rule-in rule-out strategies for myocardial infarction [29], myocardial infarction after percutaneous coronary intervention [30], and heart failure [31].…”