Abstract
There is increasing interest in measurement of cardiac troponin (cTn) levels for assessment of subjects from the community. Given the low prevalence of cardiovascular (CV) disease, the utility of cTn as a screening tool in the general population however, is debated. Measurement of cTn levels might instead be clinically useful in selected at-risk cohorts. In fact, several studies have consistently demonstrated that cTn levels in these cohorts are strong predictors of adverse outcome, mainly with respect to mortality and the development of heart failure. cTn levels also provide prognostic value beyond that obtained from standard risk assessment including measurement of other circulating biomarkers and might thus, serve as an important component in primary prevention.
In this chapter, we review the evidence on this topic including results from studies in selected at-risk cohorts, i.e. subjects with prevalent CV risk factors, diabetics and the elderly. The summarized notion from these investigations is that cTn measurements likely might serve as a ‘gatekeeper’ in the future, in particular to facilitate the identification of subjects with at-risk features in whom additional testing is needed to detect the particular source of cardiac injury and to design appropriate clinical responses.
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Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33:1635–701. Erratum in: Eur Heart J. 33:2126.
Goff DC Jr., Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;63:2935–59. Erratum in: J Am Coll Cardiol. 63:3026.
Wallace TW, Abdullah SM, Drazner MH, et al. Prevalence and determinants of troponin T elevation in the general population. Circulation. 2006;113:1958–65.
Apple FS, Ler R, Murakami MA. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012;58:1574–81.
deFilippi CR, de Lemos JA, Christenson RH, et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010;304:2494–502.
Eggers KM, Venge P, Lindahl B, et al. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol. 2013;61:1906–13.
Eggers KM, Al-Shakarchi J, Berglund L, et al. High-sensitive troponin T and its relations to cardiovascular risk factors, morbidity and mortality in elderly men. Am Heart J. 2013;166:541–8.
Dallmeier D, Denkinger M, Peter R, et al. Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults: the ActiFE study. Clin Chem. 2015;61:389–99.
Kociol RD, Pang PS, Gheorghiade M, et al. Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol. 2010;56:1071–8.
Laufer EM, Mingels AM, Winkens MH, et al. The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T. Arterioscler Thromb Vasc Biol. 2010;30:1269–75.
Kavsak PA, Xu L, Yusuf S, et al. High-sensitivity cardiac troponin I measurement for risk stratification in a stable high-risk population. Clin Chem. 2011;57:1146–53.
McQueen MJ, Kavsak PA, Xu L, et al. Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population. Clin Biochem. 2013;46:5–9.
Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.
Seshasai SR, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829–41.
Selvin E, Lazo M, Chen Y, et al. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation. 2014;130:1374–82.
Rubin J, Matsushita K, Ballantyne CM, et al. Chronic hyperglycemia and subclinical myocardial injury. J Am Coll Cardiol. 2012;59:484–9.
Zheng J, Ye P, Luo L, et al. Association between blood glucose levels and high-sensitivity cardiac troponin T in an overt cardiovascular disease-free community-based study. Diabetes Res Clin Pract. 2012;97:139–45.
Desai AS, Toto R, Jarolim P, et al. Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD. Am J Kidney Dis. 2011;58:717–28.
Welsh P, Woodward M, Hillis GS, et al. Do cardiac biomarkers NT-proBNP and hsTnT predict microvascular events in patients with type 2 diabetes? Results from the ADVANCE trial. Diabetes Care. 2014;37:2202–10.
Everett BM, Cook NR, Magnone MC, et al. Sensitive cardiac troponin T assay and the risk of incident cardiovascular disease in women with and without diabetes mellitus: the Women’s Health Study. Circulation. 2011;123:2811–8.
Hillis GS, Welsh P, Chalmers J, et al. The relative and combined ability of high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide to predict cardiovascular events and death in patients with type 2 diabetes. Diabetes Care. 2014;37:295–303.
Looker HC, Colombo M, Agakov F, et al. Protein biomarkers for the prediction of cardiovascular disease in type 2 diabetes. Diabetologia. 2015;58:1363–71.
Stolker JM, Rich MW. Aging and geriatric heart disease. In: Crawford MH, DiMarco JP, Paulus WJ, editors. Cardiology. 3rd ed. Philadelphia: Mosby Elsevier; 2010. p. 1775–90.
Masson S, Latini R, Mureddu GF, et al. High-sensitivity cardiac troponin T for detection of subtle abnormalities of cardiac phenotype in a general population of elderly individuals. J Intern Med. 2013;273:306–17.
Providência R, Paiva L, Faustino A, et al. Cardiac troponin I: Prothrombotic risk marker in non-valvular atrial fibrillation. Int J Cardiol. 2013;167:877–82.
Hammarsten O, Fu ML, Sigurjonsdottir R, et al. Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction. Clin Chem. 2012;58:628–37.
Zeller T, Tunstall-Pedoe H, Saarela O, et al. High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort. Eur Heart J. 2014;35:271–81.
Nielsen OW, McDonagh TA, Robb SD, et al. Retrospective analysis of the cost-effectiveness of using plasma brain natriuretic peptide in screening for left ventricular systolic dysfunction in the general population. J Am Coll Cardiol. 2003;41:113–20.
Mills NL, Shah AS, Mcallister DA, et al. High-sensitivity cardiac troponin I predicts long-term cardiovascular outcome in the west of Scotland coronary prevention study. Eur Heart J. 2014;35(Abstract Supplement):205.
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Eggers, K.M., Venge, P. (2016). Use of High-Sensitive cTn Assays for the Evaluation of Patients Potentially at Risk for Cardiovascular Disease. In: Maisel, A., Jaffe, A. (eds) Cardiac Biomarkers. Springer, Cham. https://doi.org/10.1007/978-3-319-42982-3_10
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DOI: https://doi.org/10.1007/978-3-319-42982-3_10
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