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High-Sensitivity Troponin T Level and Angiographic Severity of Coronary Artery Disease

      The association between circulating levels of cardiac troponins and angiographic severity of coronary artery disease (CAD) has not been studied. We investigated whether there is an association between the level of high-sensitivity troponin T (hs-TnT) and angiographic severity of CAD and whether this association is independent of conventional risk factors, N-terminal pro–brain natriuretic peptide (NT–pro-BNP) and C-reactive protein (CRP). This case–control study included 904 patients with stable CAD (cases) and 412 patients with chest pain but without significant CAD on coronary angiogram (controls). Diagnosis of CAD was confirmed or excluded by coronary angiography. Cardiac TnT was measured with conventional and high-sensitivity assays in parallel using the same plasma sample. In patients with no CAD and in those with 1-, 2-, or 3-vessel disease, hs-TnT levels (median, twenty-fifth to seventy-fifth percentiles) were 0.005 μg/L (<0.003 to 0.009), 0.006 μg/L (0.003 to 0.011), 0.008 μg/L (0.004 to 0.013), and 0.010 μg/L (0.006 to 0.017), respectively (p <0.001). In multivariable analysis adjusting for cardiovascular risk factors and clinical variables including NT–pro-BNP and CRP, hs-TnT was an independent predictor of presence of CAD (adjusted odds ratio 1.30, 95% confidence interval 1.07 to 1.59, p = 0.009). In conclusion, in patients with stable and angiographically proved CAD, hs-TnT level is increased compared to subjects without CAD and correlates with angiographic atherosclerotic extent and burden. The association between increased levels of hs-TnT and presence of CAD was independent of traditional cardiovascular risk factors, NT–pro-BNP, and CRP.
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      References

        • Venge P.
        • Johnston N.
        • Lindahl B.
        • James S.
        Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I access prototype assay and the impact on the diagnosis of myocardial ischemia.
        J Am Coll Cardiol. 2009; 54: 1165-1172
        • Ndrepepa G.
        • Braun S.
        • Mehilli J.
        • Birkmeier K.A.
        • Byrne R.A.
        • Ott I.
        • Hösl K.
        • Schulz S.
        • Fusaro M.
        • Pache J.
        • Hausleiter J.
        • Laugwitz K.L.
        • Massberg S.
        • Seyfarth M.
        • Schömig A.
        • Kastrati A.
        Prognostic value of sensitive troponin T in patients with stable and unstable angina and undetectable conventional troponin.
        Am Heart J. 2011; 161: 68-75
        • Omland T.
        • de Lemos J.A.
        • Sabatine M.S.
        • Christophi C.A.
        • Rice M.M.
        • Jablonski K.A.
        • Tjora S.
        • Domanski M.J.
        • Gersh B.J.
        • Rouleau J.L.
        • Pfeffer M.A.
        • Braunwald E.
        A sensitive cardiac troponin T assay in stable coronary artery disease.
        N Engl J Med. 2009; 361: 2538-2547
        • Keller T.
        • Zeller T.
        • Peetz D.
        • Tzikas S.
        • Roth A.
        • Czyz E.
        • Bickel C.
        • Baldus S.
        • Warnholtz A.
        • Fröhlich M.
        • Sinning C.R.
        • Eleftheriadis M.S.
        • Wild P.S.
        • Schnabel R.B.
        • Lubos E.
        • Jachmann N.
        • Genth-Zotz S.
        • Post F.
        • Nicaud V.
        • Tiret L.
        • Lackner K.J.
        • Munzel T.F.
        • Blankenberg S.
        Sensitive troponin I assay in early diagnosis of acute myocardial infarction.
        N Engl J Med. 2009; 361: 868-877
        • Giannitsis E.
        • Becker M.
        • Kurz K.
        • Hess G.
        • Zdunek D.
        • Katus H.A.
        High-sensitivity cardiac troponin T for early prediction of evolving non–ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission.
        Clin Chem. 2010; 56: 642-650
        • Januzzi Jr, J.L.
        • Bamberg F.
        • Lee H.
        • Truong Q.A.
        • Nichols J.H.
        • Karakas M.
        • Mohammed A.A.
        • Schlett C.L.
        • Nagurney J.T.
        • Hoffmann U.
        • Koenig W.
        High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.
        Circulation. 2010; 121: 1227-1234
        • Lindahl B.
        • Venge P.
        • James S.
        The new high-sensitivity cardiac troponin T assay improves risk assessment in acute coronary syndromes.
        Am Heart J. 2010; 160: 224-229
        • deFilippi C.R.
        • de Lemos J.A.
        • Christenson R.H.
        • Gottdiener J.S.
        • Kop W.J.
        • Zhan M.
        • Seliger S.L.
        Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults.
        JAMA. 2010; 304: 2494-2502
        • de Lemos J.A.
        • Drazner M.H.
        • Omland T.
        • Ayers C.R.
        • Khera A.
        • Rohatgi A.
        • Hashim I.
        • Berry J.D.
        • Das S.R.
        • Morrow D.A.
        • McGuire D.K.
        Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population.
        JAMA. 2010; 304: 2503-2512
        • Apple F.S.
        High-sensitivity cardiac troponin for screening large populations of healthy people: is there risk?.
        Clin Chem. 2011; 57: 537-539
        • Korosoglou G.
        • Lehrke S.
        • Mueller D.
        • Hosch W.
        • Kauczor H.U.
        • Humpert P.M.
        • Giannitsis E.
        • Katus H.A.
        Determinants of troponin release in patients with stable coronary artery disease: insights from CT angiography characteristics of atherosclerotic plaque.
        Heart. 2011; 97: 823-831
        • Laufer E.M.
        • Mingels A.M.
        • Winkens M.H.
        • Joosen I.A.
        • Schellings M.W.
        • Leiner T.
        • Wildberger J.E.
        • Narula J.
        • Van Dieijen-Visser M.P.
        • Hofstra L.
        The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T.
        Arterioscler Thromb Vasc Biol. 2010; 30: 1269-1275
        • Schulz O.
        • Reinicke M.
        • Berghoefer G.H.
        • Bensch R.
        • Kraemer J.
        • Schimke I.
        • Jaffe A.S.
        High-sensitive cardiac troponin I (hs-cTnI) values in patients with stable cardiovascular disease: An initial foray.
        Clin Chim Acta. 2010; 411: 812-817
        • Ndrepepa G.
        • Braun S.
        • Schulz S.
        • Fusaro M.
        • Keta D.
        • Pache J.
        • Seyfarth M.
        • Mehilli J.
        • Schömig A.
        • Kastrati A.
        Sensitive troponin and N-terminal probrain natriuretic peptide in stable angina.
        Eur J Clin Invest. 2011; ([Epub ahead of print])
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Gensini G.G.
        A more meaningful scoring system for determining the severity of coronary heart disease.
        Am J Cardiol. 1983; 51: 606
        • Sandler H.
        • Dodge H.T.
        The use of single plane angiocardiograms for the calculation of left ventricular volume in man.
        Am Heart J. 1968; 75: 325-334
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Agewall S.
        • Giannitsis E.
        • Jernberg T.
        • Katus H.
        Troponin elevation in coronary vs. non-coronary disease.
        Eur Heart J. 2011; 32: 404-411
        • Giannoni A.
        • Giovannini S.
        • Clerico A.
        Measurement of circulating concentrations of cardiac troponin I and T in healthy subjects: a tool for monitoring myocardial tissue renewal?.
        Clin Chem Lab Med. 2009; 47: 1167-1177
        • Davies M.J.
        Stability and instability: two faces of coronary atherosclerosis.
        Circulation. 1996; 94: 2013-2020
        • Sabatine M.S.
        • Morrow D.A.
        • de Lemos J.A.
        • Jarolim P.
        • Braunwald E.
        Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35.
        Eur Heart J. 2009; 30: 162-169
        • Communal C.
        • Sumandea M.
        • de Tombe P.
        • Narula J.
        • Solaro R.J.
        • Hajjar R.J.
        Functional consequences of caspase activation in cardiac myocytes.
        Proc Natl Acad Sci U S A. 2002; 99: 6252-6256
        • Hickman P.E.
        • Potter J.M.
        • Aroney C.
        • Koerbin G.
        • Southcott E.
        • Wu A.H.
        • Roberts M.S.
        Cardiac troponin may be released by ischemia alone, without necrosis.
        Clin Chim Acta. 2010; 411: 318-323
        • Diris J.H.
        • Hackeng C.M.
        • Kooman J.P.
        • Pinto Y.M.
        • Hermens W.T.
        • van Dieijen-Visser M.P.
        Impaired renal clearance explains elevated troponin T fragments in hemodialysis patients.
        Circulation. 2004; 109: 23-25