Elevated hs-cTnT Research Articles

Associations of High-Sensitivity Cardiac Troponin and Natriuretic Peptide With Subsequent Risk of Infection in Persons Without Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

Whether persons without prevalent cardiovascular disease (CVD) but elevated levels of high-sensitivity cardiac troponin T (hs-cTnT) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) are at high risk of infection is unknown. Using 1996-2013 data from the Atherosclerosis Risk in Communities Study, we estimated hazard ratios for incident hospitalization with infection in relation to plasma hs-cTnT and NT-proBNP concentrations among participants without prevalent CVD and contrasted them with hazard ratios for persons with prevalent CVD (coronary heart disease, heart failure, or stroke). In a multivariable Cox model, prevalent CVD was significantly associated with risk of hospitalization with infection (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 1.19, 1.45). Among participants without prevalent CVD, hs-cTnT and NT-proBNP were independently associated with infection risk in a graded fashion (e.g., HR = 1.44 (95% CI: 1.24, 1.69) for hs-cTnT ≥14 ng/L and HR = 1.28 (95% CI: 1.14, 1.44) for hs-cTnT 9-13 ng/L vs. <3 ng/L; HR = 1.57 (95% CI: 1.35, 1.81) for NT-proBNP ≥248.1 pg/mL and HR = 1.19 (95% CI: 1.06, 1.34) for NT-proBNP 137.2-248.0 pg/mL vs. <48.1 pg/mL). The 15-year cumulative incidences of hospitalization with infection were similar for participants with prevalent CVD and participants who did not have prevalent CVD but had hs-cTnT ≥14 ng/L or NT-proBNP ≥248.1 pg/mL. Thus, hs-cTnT and NT-proBNP were independently associated with infection risk. Persons without CVD but with elevated hs-cTnT or NT-proBNP levels should be recognized to have similar infection risks as persons with prevalent CVD.

Cardiac Magnetic Resonance Imaging in Patients with Acute Ischemic Stroke and Elevated Troponin: A TRoponin ELevation in Acute Ischemic Stroke (TRELAS) Sub-Study

Background: Elevated high-sensitive cardiac troponin (hs-cTn) can be found in more than 50% of the patients with acute ischemic stroke. The observational TRoponin ELevation in Acute ischemic Stroke (TRELAS) study revealed that about 25% of all stroke patients with elevated troponin had a coronary angiography-detected culprit lesion affording immediate intervention, and about 50% of all patients did not have any obstructive coronary artery disease. Given the risk of procedure-related complications, the identification of stroke patients in urgent need of invasive coronary angiography is desirable. Methods: TRELAS patients were prospectively enrolled into this sub-study. In addition to conventional coronary angiography, a cardiac magnetic resonance imaging (MRI) at 3T was performed during the in-hospital stay after acute ischemic stroke to compare the diagnostic value of both imaging modalities. Results:Nine stroke patients (median age 73 years [range 58–87]; four females; median NIH Stroke Severity score on admission 4 [range 0–6] with elevated hs-cTnT [median 74 ng/L, interquartile range 41–247] on admission) completed cardiac MRI and underwent coronary angiography. The absence of MRI-detected wall motion abnormalities and/or late gadolinium enhancement in 5 stroke patients corresponded with the exclusion of culprit lesions or significant coronary artery disease by coronary angiography. Four patients had abnormal MRI findings, whereof 2 showed evidence of myocardial infarction and in whom coronary angiography demonstrated a >70% stenosis of a coronary artery. Conclusions: The TRELAS sub-study indicates that noninvasive cardiac MRI may provide helpful information to identify stroke patients with or without acute coronary syndrome. Our findings might help to select stroke patients in urgent need of coronary angiography.

Relation of Isolated Systolic Hypertension and Pulse Pressure to High-Sensitivity Cardiac Troponin-T and N-Terminal pro-B-Type Natriuretic Peptide in Older Adults (from the Atherosclerosis Risk in Communities Study)

Isolated systolic hypertension (ISH) and elevated pulse pressure (PP) are common blood pressure (BP) abnormalities in older adults, reflect poor vascular compliance, and can signify risk for cardiovascular outcomes. We sought to characterize the associations of ISH and widened PP with high-sensitivity Troponin-T (hs-cTnT; a marker of myocardial damage) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; a marker of hemodynamic stress) levels in older adults. We performed a cross-sectional analysis of 5,251 Atherosclerosis Risk in Communities (ARIC) study participants without heart failure who attended visit 5 (2011 to 2013). We used logistic regression to evaluate the association of ISH (systolic BP ≥140 mm Hg and diastolic BP < 90 mm Hg) and quartiles of PP with detectable (≥5 ng/L) and elevated hs-cTnT (≥14 ng/L); as well as elevated NT-proBNP (≥100 pg/mL). The mean age was 75 years, 58% were women, and 78% were white. ISH was present in 24.7% and PP ≥ 70 mm Hg in 30.3% of this cohort. Compared to participants with nonhypertensive BP (<140/90 mm Hg), ISH was independently associated with hs-cTnT and NT-proBNP; adjusted odds ratio of 1.5 (95% confidence interval: 1.1 to 1.9) for detectable hs-cTnT; 1.3 (1.1 to 1.5) for elevated hs-cTnT; and 1.8 (1.6 to 2.1) for elevated NT-proBNP. Increasing quartiles of PP were also significantly associated with both elevated hs-cTnT (p-for-trend <0.0001) and NT-proBNP (p-for-trend <0.0001). These associations were not modified by BP treatment status. In conclusion, ISH and wide PP are relatively common in older adults despite contemporary BP treatment and are associated with abnormalities in hs-cTnT and NT-pro BNP, findings that could guide personalized treatment of older patients with these BP aberrations.

Cancer Survivorship and Subclinical Myocardial Damage.

Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicities of cancer therapies and a high burden of CVD risk factors. We sought to evaluate the association of cancer survivorship with subclinical myocardial damage, as assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT) test results. We included 3,512 participants of the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013) and were free of CVD (coronary heart disease, heart failure, or stroke). We used multivariate logistic regression to evaluate the cross-sectional associations of survivorship from any, non-sex-related, and sex-related cancers (e.g., breast, prostate) with elevated hs-cTnT (≥14 ng/L). Of 3,512 participants (mean age, 76 years; 62% women; 21% black), 19% were cancer survivors. Cancer survivors had significantly higher odds of elevated hs-cTnT (OR = 1.26, 95% CI: 1.03, 1.53). Results were similar for survivors of non-sex-related and colorectal cancers, but there was no association between survivorship from breast and prostate cancers and elevated hs-cTnT. Results were similar after additional adjustments for CVD risk factors. Survivors of some cancers might be more likely to have elevated hs-cTnT than persons without prior cancer. The excess burden of subclinical myocardial damage in this population might not be fully explained by traditional CVD risk factors.

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

Our objective was to assess the impact of hs-cTnT elevation on functional outcome and mortality in AIS patients with large vessel occlusion (LVO) in the anterior circulation 3 months after ET and explore factors affecting hs-cTnT elevation.A total of 143 consecutive AIS patients with large vessel occlusion (LVO) in the anterior circulation following ET in a single stroke center were enrolled between January 2015 and November 2017. Hs-cTnT was quantitated on admission. Demographic characteristics, clinical data, functional outcome and all-cause mortality were compared between patients with elevated hs-cTnT levels (>14 ng/L) and those with normal hs-cTnT levels (≤14 ng/L). 58/143(40.6%) patients showed elevated hs-cTnT levels before ET. Factors independently associated with hs-cTnT elevation were admission NIHSS score (OR = 1.08, 95% CI 1.01–1.16, p = 0.032), coronary heart disease (OR = 4.89, 95% CI 1.82–13.11, p = 0.002) and congestive heart failure (OR = 4.10, 95% CI 1.07–15.68, p = 0.039). In the univariate analysis, patients with elevated hs-cTnT levels were at significantly higher risk of 3-month poor outcome (p = 0.029) and mortality (p < 0.001) than those with normal hs-cTnT levels. After multivariable analysis, hs-cTnT elevation remained an independent predictor of 3-month mortality (OR = 4.49, 95% CI 1.68–11.98, p = 0.003). In this cohort of AIS patients with LVO in the anterior circulation undergoing ET, hs-cTnT elevation is an independent predictor of 3-month mortality. Admission NIHSS score, coronary heart disease and congestive heart failure are independently associated with elevated hs-cTnT levels.

Abstract MP44: Association of High-Sensitivity Troponin With Peripheral Neuropathy in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: High-sensitivity cardiac troponin (hs-cTnT) is a marker of myocardial damage and has been associated with diabetes and its major complications, particularly those with a microvascular etiology. The aim of this study was to assess the association of hs-cTnT and other cardiac, kidney, inflammation, and hyperglycemia biomarkers with peripheral neuropathy (PN) in both diabetic and non-diabetic populations. Methods: We conducted a cross-sectional analysis of 3,019 black and white participants in the ARIC study who underwent monofilament PN testing and had hs-cTnT and other nontraditional measures [NT-proBNP, high-sensitivity C-reactive protein, β-2 microglobulin, creatinine-based estimated glomerular filtration rate (eGFR), cystatin C-based eGFR, urine albumin:creatinine ratio, fructosamine, glycated albumin, and 1,5-anhydroglucitol] assessed at ARIC visit 6 (2016-2017, age 71-94 years). We used logistic regression models to assess the associations of these biomarkers with the presence of PN in older adults with and without diabetes after adjusting for traditional diabetes and cardiovascular risk factors. Results: Overall, 38.0% of the 3,019 participants had evidence of PN (42.0% in persons with diabetes and 36.4% in persons without diabetes). After adjusting for traditional risk factors, there were significant and robust associations of hs-cTnT, NT-proBNP, and β-2 microglobulin with PN ( Table, Model 2 ). After further adjusting for hemoglobin A1c, only the association of hs-cTnT with PN remained significant (P=0.02; Model 3 ). Elevated hs-cTnT (≥14 ng/L) was associated with prevalent PN in persons with diabetes (OR 2.10, 95%CI 1.24-3.56) and without diabetes (OR 2.61, 95% CI 1.59-4.28) compared to persons without diabetes and non-elevated hs-cTnT (&lt;6 ng/L). Conclusions: Hs-cTnT is associated with the presence of PN in older adults independent of cardiovascular risk factors and glycemic control. These findings support the hypothesis that hs-cTnT may be a global marker of end organ damage.

CAUSES OF ELEVATED HIGH SENSITIVITY TROPONIN T IN CONSECUTIVE EMERGENCY DEPARTMENT PATIENTS

There is a need to understand when elevations in high sensitivity troponin (hs-cTn) can be expected. We prospectively measured 1,160 consecutive serial (0, 3 and 6 hour) samples from the ED with 4th and 5th generation cTnT. An elevated hs-cTnT was ≥10 ng/L in women, >15 ng/L in men and

Abstract TP100: Elevation of Admission High-Sensitivity Cardiac Troponin T is Associated With Increased Discharge Disability in Acute Ischemic Stroke Patients Treated With Thrombolysis

Introduction: Elevated levels of cardiac troponin T (cTnT) has been demonstrated to be associated with greater stroke severity, worse clinical outcome and increased mortality. Few studies have discussed the predictive value of high-sensitivity cTnT(hs-cTnT) in thrombolysed patients with acute ischemic stroke (AIS). In the present study, we investigate whether elevated levels of hs-cTnT is associated with greater stroke severity and worse clinical outcomes in Chinese AIS patients treated with intravenous tissue-type plasminogen activator (IV tPA). Methods: From January 2017 to February 2018, we prospectively recruited a total of 249 AIS patients treated with IV tPA within 4.5 hours of onset.Hs-cTnT assays were performed on admission and prior to thrombolysis in all these patients.Patients were stratified into either normal or elevated hs-cTnT groups according to a cut-off value of 14 ng/L of the admission hs-cTnT level. Adjusted odds ratios and related 95% confidence intervals were assessed based on multivariable logistic regression model. Results: In the univariate comparisons, older age, higher NIHSS on admission, lower eGFR, history of diabetes mellitus, coronary heart disease or atrial fibrillation, involvement of insular cortex and cardioembolism were significantly associated with elevated hs-cTnT levels.In the univariate comparisons,hs-cTnT elevation was significantly associated with disability at discharge(14 days mRS &gt; 2) ( p &lt;0.001, OR 3.733, 95% CI 2.019-6.905) and 30 days mortality( p =0.002, OR 8.190, 95% CI 2.101-31.935).After adjusting for demographic and clinical characteristics in multivariable analysis, hs-cTnT elevation was still significantly associated with disability at discharge ( p &lt; 0.05, OR 2.82, 95% CI 1.02-7.77). Thirty days mortality showed an increasing trend ( p = 0.09, OR 4.093, 95% CI 0.81-20.70) in hs-cTnT elevated group. Conclusions: Hs-cTnT elevation is associated with increased disability at discharge in AIS patients treated with IV tPA. Further analyses with regard to neurological severity (NIHSS) and disability (mRS)respectively at the time point of discharge, 30 days and 90 days are in process.

TUSARC: Prognostic Value of High-Sensitivity Cardiac Troponin T Assay in Asymptomatic Patients with High Cardiovascular Risk

BackgroundPrognostic value of high-sensitivity cardiac troponin T (hs-cTnT) assays have been assessed in selected populations in different studies and in registries of members of the general population with low cardiovascular risk. The aim of this study was to determine the prognostic value of hs-cTnT in an asymptomatic very-high cardiovascular risk Spanish population. MethodsFrom a previous prospective cohort of the TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow-up was conducted in 602 patients (93.18%). The association of high hs-cTnT (≥99th percentile value) and incidence of primary event was studied. A primary event was defined as a combined major cardiovascular event (incidence of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction, or coronary revascularization). The association between high hs-cTnT and incidence of secondary events was studied as well. ResultsIn patients with high hs-cTnT, the incidence of primary event during follow-up was significantly higher (18.30% vs 3.67% P < .001): heart failure (6.25% vs 0.73% P < .001), cardiovascular death (7.29% vs 0.00% P < .001), and death from any cause (7.81% vs 0.98% P < .001). ConclusionsIn an asymptomatic very-high cardiovascular risk Spanish population, elevated hs-cTnT was significantly associated with incident major cardiovascular combined end point and incidence of heart failure, cardiovascular death, and death from any cause.

Abstract 17187: The Association of Longitudinal Patterns of Metabolic Syndrome With Elevated hs-cTnT: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Longitudinal increases in metabolic syndrome (MS) components are associated with increased heart failure (HF) risk, but the association of MS change over time with subclinical myocardial injury is unknown. Hypothesis: Greater progression and duration of MS is associated with subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin T (hs-cTnT). Methods: We studied 8,170 participants (mean age 63, 59% female) without coronary heart disease, HF or diabetes at ARIC Visit 4 (1996-1998) with available data on MS components from the first four ARIC visits and hs-cTnT data at Visit 4. We defined MS using AHA/NHLBI criteria for high waist circumference (WC), hyperglycemia, elevated blood pressure (BP), low HDL-C and hypertriglyceridemia, with a diagnosis of MS made by ≥ 3 components. Using data on MS components from Visit 1 (1987-89) through 4, we used logistic regression models adjusted for demographics and cardiovascular risk factors to evaluate associations of changes in MS components over time and duration of MS with elevated hs-cTnT (≥ 14 ng/L) at Visit 4. Results: 3,644 (45%) of Visit 4 participants had MS. Greater number of MS components at Visit 4 was associated with a higher likelihood of elevated hs-cTnT, with the highest odds seen for those with 5 MS components (OR 2.32; 95%CI: 1.39-3.87) compared to those with none. Among MS components, the strongest associations were seen for elevated BP and high WC. Among participants without MS at V1, those with no MS components at both Visits 1 and 4 had the lowest odds of elevated hs-cTnT (reference), with progressively higher likelihood of elevated hs-cTnT for those increasing to 1-2 (OR 1.12; 95%CI 0.61-2.06), 3 (OR 1.90; 95%CI 1.04-3.45) and 4-5 (OR 2.64; 95%CI 1.41-4.92) MS components by Visit 4. MS duration was also significantly associated with elevated hs-cTnT, with an OR of 1.08 (95%CI: 1.06-1.11) per year of MS duration. Conclusions: Greater MS severity and progression, and longer duration of MS, are associated with a higher likelihood of subclinical myocardial injury. This may have mechanistic implications for the association between MS and HF, and underscores the need to refine strategies to prevent MS onset and progression.

Cardiac troponin T and NT-proBNP as diagnostic and prognostic biomarkers of primary cardiac involvement and disease severity in systemic sclerosis: A prospective study

ObjectivesThe aim of our study was to define the role of high-sensitive cardiac troponin T (hs-cTnT) and NT-proBNP in identifying Systemic Sclerosis (SSc) patients with cardiac involvement and at higher risk of cardiac death. MethodsPlasma hs-cTnT and NT-proBNP concentrations were measured in 245 SSc-patients. Resultshs-cTnT and NT-proBNP levels were higher in SSc-patients than in healthy controls. Hs-cTnT levels were higher than 0.014 ng/ml in 32.3% SSc-patients, while NT-proBNP was above 125 pg/ml in 31.8% of them, irrespective of classical cardiovascular risk factor and of pulmonary arterial hypertension. Elevated hs-cTnT and NT-proBNP were associated with diffuse skin involvement and directly correlated with the skin score. Patients with increased cardiac markers presented a lower left-ventricular ejection fraction (LVEF) and a higher rate of right bundle branch block (RBBB) on electrocardiogram (ECG) compared to patients with normal cardiac enzymes.During the follow-up, 12 SSc-patients experience a disease-related death; 9 of these were directly related to cardiac involvement (sudden cardiac death or heart failure) and the majority of them occurred among patients with increase of at least one cardiac biomarker. Long-term survival was worse in patients with increase of both cardiac biomarkers. ConclusionsEvaluation of hs-cTnT and NT-proBNP levels may provide a tool to screen non-invasively SSc-patients for heart involvement. A higher incidence of impaired systolic function, ECG abnormalities and a poor outcome in SSc-patients with elevated cardiac enzymes suggests that they may be valuable screening biomarkers to detect a cardiac damage at early stages and to improve risk stratification.

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

Cardiac troponin (hs-cTnT) is a sensitive marker of myocardial injury and has been linked to incident dementia. The underlying mechanism of that observation is still unknown. Given that severity of cerebral small vessel disease is a predictor of cognitive decline, we aimed to explore whether there is an association between hs-cTnT and severity of white matter lesions (WML) as a marker of cerebral small vessel disease in patients with ischemic stroke. We analyzed consecutive acute ischemic stroke patients admitted to Charité-University Hospital, Berlin from 2011 to 2013. Severity of WML was graded on 3T-MRI using the age-related white matter severity score (ARWMS). Patients with hs-cTnT elevation suggestive of acute coronary syndrome (ACS) were excluded (hs-cTnT > 52ng/l or dynamic change of hs-cTnT > 50%, ESC guideline). We performed unadjusted and adjusted quantile regression models to assess the association between increased hs-cTnT (dichotomized at the 99th percentile, 14ng/l) and severity of WML. A total of 860 patients was analyzed (median age 73years, 44.8% female, median ARWMS 6). Patients with elevated hs-cTnT had more extensive WML than those without (median ARWMS 8 vs. 5, adjusted beta for 50th percentile 1.12, 95% CI 0.41-1.84). The association between WML and hs-cTnT elevation was strongest in patients with severe WML (adjusted beta 1.77, 95% CI 0.26-3.27 for 80th WML percentile). Elevated hs-cTnT levels were associated with extent of WML in acute stroke patients. Further studies are needed to assess whether hs-cTnT can be used to identify stroke patients at risk for cognitive decline.

72 Do High Sensitivity Troponin and Natriuretic Peptide Predict Cardiac Outcomes After Syncope?

To determine if high sensitivity troponin (hs-cTnT) and N-Terminal Brain Natriuretic Peptide (NT-pro BNP) at the emergency department (ED) index visit are independently associated with 30-day death/serious cardiac outcomes in adult ED patients with syncope. This study is a pre-specified secondary analysis of a prospective, observational trial (NCT01802398) conducted across 11 academic hospital EDs in the US, enrolling patients ≥60 yrs presenting with syncope or near syncope between 4/2013-9/2016. Patients were excluded if they presented with seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia or had persistent confusion, required mechanical/electrical intervention, lacked phone access or a permanent address, or did not speak English or Spanish. Within 3 hours of informed consent Hs-cTnT and NT-proBNP samples were collected and later analyzed in a central laboratory using Roche Elecsys Gen 5 STAT® and 2010 Cobas® respectively. Results were analyzed in all patients who had at least 1 biomarker against our primary outcome of all 30-day serious cardiac outcomes and all-cause mortality. We used multivariate logistic regression models to estimate the association between the primary outcome and biomarker levels, adjusting for measures of illness severity. We estimated adjusted absolute risk associated with ranges of biomarker levels using Bayesian Markov Chain Monte Carlo. Likelihood ratios and predictive values were calculated. Of 3,392 patients 367 (10.8%) patients experienced the primary outcome. Adjusted absolute risk for the primary outcome increased as a function of both hs-cTnT and NT-pro BNP levels. Hs-cTnT level ≤ 5 ng/L were associated with a 4% (95CI: 3-5%) risk of outcome, hs-cTnT >50 ng/L were associated with a 29% (95CI: 26-33%) risk of outcome. NT-pro BNP level ≤125 ng/L were associated with a 4% (95CI: 4-5%) risk of outcome, NT-pro BNP >2000 ng/L were associated with a 29% (95CI: 25-32%) risk of outcome. Likelihood ratios and predictive values showed similar results for both biomarkers (Table). Associations did not change significantly when we excluded patients who had a serious outcome found during the ED index visit. Elevated hs-cTnT and NT-proBNP are independent predictors of 30-day death and serious cardiac events in older patients presenting to the ED for syncope and near syncope.

Prediction of coronary heart disease or heart failure using high-sensitivity cardiac troponin T: A pilot study.

High-sensitivity cardiac troponin T (hs-cTnT) is a good prognostic marker for mortality. However, it is uncertain if hs-cTnT can be used to detect sub-clinical cardiac disease. Pilot study in patients without known heart disease and elevated hs-cTnT measured at presentation to the emergency department. Hs-cTnT was measure with Roche Diagnostics. Echocardiography was used to assess structural heart disease and the participants underwent computed tomography angiography for assessment of coronary artery disease and agatston score. Ten patients were included in the final cohort. Median age was 68 years IQR (57-78) and 80% were female (n=8). Six patients had a history of chronic obstructive lung disease and five patients had history of hypertension. The median level of hs-cTnT was 26ng/L and values ranged from 19ng/L to 495ng/L. The median calcium score was 12. Three patients had signs of coronary artery disease. All patients had normal left ventricular ejection fraction with a median LVEF at 54.5%. Two patients were noted to have increased left ventricular mass index (LVMI). The majority of patients with hs-cTnT above the 99th percentile did not have structural heart disease or ischaemic coronary disease. However, 30% of the patient did have signs of coronary disease and might benefit from preventive medical treatment. Measuring hs-cTnT in the absence of acute illness might be a better approach for evaluation for sub-clinical cardiac disease.

The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke

BackgroundCardiac autonomic dysfunction caused by ischemic stroke might lead to an adverse outcome. Elevated high sensitivity cardiac troponin (hs-cTnT) is a marker of cardiac disease, it can elevate in acute stroke patients. The aim of the present study was to investigate association between serum hs-cTnT with prognosis among patients with acute ischemic stroke.MethodsFive hundred and sixteen patients (mean age 66.19 ± 10.11) with acute ischemic stroke underwent a comprehensive clinical investigation and serum hs-cTnT activity test. All patients were followed up for 3 months. The prognosis was death or major disability (modified Rankin Scale score ≥ 3) at 3 months after acute ischemic stroke.Results22.87% (118/516) of patients had serum hs-cTnT elevation (≥14 ng/l). Compared with normal hs-TnT group, the incidence of insular stroke (adjusted odds ratio, 2.84; 95% confidence interval, 1.48–4.17; P = 0.001) were more likely in patients with hs-cTnT elevation. In fully adjusted models, there was an association between serum hs-cTnT elevation and death (adjusted odds ratio, 3.14; 95% confidence interval, 1.16–8.49; P = 0.02) and major disability(adjusted odds ratio, 2.07; 95% confidence interval, 1.04–4.51; P = 0.04), and composite outcome(adjusted odds ratio,2.22;95% confidence interval,1.10–4.48; P = 0.03).ConclusionsHigher levels of serum hs-cTnT were independently associated with increased risk of death or major disability after stroke onset, suggesting that serum hs-cTnT may have prognostic value in poor outcomes of ischemic stroke.

Non-coronary predictors of elevated high-sensitive cardiac troponin T (hs-cTnT) levels in an unselected emergency patient cohort.

Aim of this study was to evaluate the predictors of hs-cTnT in a non-ACS patient cohort admitted to the emergency department. Atrial fibrillation and hypertension may not always be sufficient for elevation for hs-cTnT. We performed a retrospective, single center study encompassing in total 1003 patients. Individuals were retrospectively divided in ACS- and non-ACS patients by two independent investigators reviewing the medical records. In order to identify predictors of hs-cTnT elevation hazard ratios were calculated for age, gender, vital signs, cardiovascular risk factors, LVEF, serum levels of CRP, hemoglobin, and creatinine. Elevation of hs-cTnT was defined by exceeding 14 ng/L (upper reference limit [URL]). About 987 patients were included while 25 patients were excluded because of missing data. 307 patients (31.4%) met the current guideline requirements of diagnosing an ACS, whereas 671 patients (68.6%) were hospitalized with excluded ACS. In the multivariate analysis age, anemia, CRP, creatinine, and reduced systolic left ventricular ejection fraction were independent predictors of elevated troponin T levels in the non-ACS group. However, hypertensive systolic blood pressure, atrial fibrillation and tachycardia were not predictive for Troponin T elevation in non-ACS patients in this multivariate analysis. In an unselected, non-ACS patient cohort age, chronic renal failure, inflammatory state, and reduced left ventricular systolic function were associated with hs-cTnT levels above the upper reference limit. Rather, often supposed predictors as atrial fibrillation, hypertension, and tachycardia cannot sufficiently explain increased hs-cTnT in our study. Hence, further studies are needed to assess whether isolated hypertension, tachycardia, or atrial fibrillation sufficiently explain elevated hs-cTnT.

Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

BackgroundWe aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. MethodsWe measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. ResultsMajor cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0–2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59–0.75) for hs-cTnI versus 0.59 (95% CI 0.51–0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3–2.0, and aOR 3.0, 95% CI 2.0–4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71–0.83, and 0.79, 95% CI 0.73–0.85, P = ns). ConclusionsPreoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.

Elevated high‐sensitive troponin T in negative stress test individuals

The exercise ECG stress test (EST) is still the first step of work-up in intermediate risk patients in many clinical scenarios. High-sensitive cardiac troponin T (hs-cTnT) elevation is related to future cardiovascular events in the general population and in patients with ischaemic heart disease. The relation between these 2 tests is not well described. A total of 2780 participants from the Tel-Aviv Medical Center Inflammation Survey cohort (mean age 49 years, 79% men) were analysed. Multiple physiologic and metabolic parameters including hs-cTnT were collected. All participants completed an EST manually reviewed by a cardiologist. A positive EST was documented in 224 subjects (8%). The majority (91%) of participants with hs-cTnT levels of 5-14 ng/L had a negative EST as well as 89.3% of subjects with levels >14 ng/L. The proportion of subjects with a positive EST and detectable hs-cTnT levels (>5 ng/L) was not significantly greater compared to those with a negative EST (53.1% vs 46.2%, respectively, P = .09). Among subjects referred for EST as part of an annual health survey, we found no significant association between EST results to hs-cTnT detection.

Serum Cardiac Troponin T Levels in Asymptomatic Elderly Nursing Home Residents

BackgroundThe definition of myocardial infarction relies on elevated troponin levels. However, elevated levels of high sensitive cardiac troponin (hs-cTnT) assays have been reported in elderly patients without acute myocardial infarction. We sought to determine whether elevated hs-cTnT levels have a prognostic value in stable elderly subjects without any acute illness. MethodsThe study cohort included residents of a nursing home who were asymptomatic without any acute medical problem. Serum hs-cTnT levels were measured, and participants were divided into high and low hs-cTnT groups. We measured hs-cTnT levels of young healthy volunteers as well and compared them with hs-cTnT levels of those nursing home residents. ResultsFifty-seven nursing home residents and 14 young volunteers were included in the study. The average age of nursing home residents was 83 ± 14 years, compared with 37 ± 3 years of the volunteers. Levels of hs-cTnT were significantly higher in the elderly compared with the volunteers (0.02 ± 0.016 ng/mL vs 0.005 ± 0.0003 ng/mL; P < .001); accordingly, we chose a cutoff of 0.02 ng/mL hs-cTnT and divided the 57 patients into 2 subgroups for further evaluation. After adjustment for age, gender, and glomerular filtration rate, the hs-cTnT was still an independent predictor of 1-year mortality (relative risk 2.04 [95% conficence interval, 2.009-29.45], P = .003). ConclusionsMild elevations of hs-cTnT levels are common in elderly patients, and hs-cTnT level is an independent marker of mortality risk in this population. For patients older than 70 years, a different hs-cTnT cutoff is required (eg, higher than 0.014 ng/mL).

High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery

BackgroundIt is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. MethodsIn this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2–6 h, and 18–30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre−1; men >15 ng litre−1). ResultsAmongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50–84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre−1, 12 patients (13%) between 2 and 4 ng litre−1, three patients between 4 and 6 ng litre−1, and one patient (1%) between 6 and 8 ng litre−1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9–5, inter-quartile range) ng litre−1 at baseline, 4 (3.9–5) ng litre−1 at 2–6 h after surgery, and 4 (3.9–5) ng litre−1 on postoperative day 1. ConclusionsOne in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. Clinical trial registrationNCT 02394288.