1. High-Sensitivity Cardiac Troponin T Levels and Secondary Events in Outpatients With Coronary Heart Disease From the Heart and Soul Study
- Author
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Beatty, Alexis L, Ku, Ivy A, Christenson, Robert H, DeFilippi, Christopher R, Schiller, Nelson B, and Whooley, Mary A
- Subjects
Cardiovascular ,Heart Disease ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Aetiology ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,2.1 Biological and endogenous factors ,Adult ,Aged ,Ambulatory Care Facilities ,Biomarkers ,C-Reactive Protein ,Coronary Disease ,Death ,Sudden ,Cardiac ,Echocardiography ,Stress ,Exercise Test ,Female ,Follow-Up Studies ,Heart Failure ,Humans ,Male ,Middle Aged ,Myocardial Infarction ,Natriuretic Peptide ,Brain ,Outpatients ,Predictive Value of Tests ,Prospective Studies ,Risk Factors ,San Francisco ,Sensitivity and Specificity ,Severity of Illness Index ,Surveys and Questionnaires ,Troponin T ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services - Abstract
ImportanceLevels of high-sensitivity cardiac troponin T (hs-cTnT) predict secondary cardiovascular events in patients with stable coronary heart disease.ObjectivesTo determine the association of hs-cTnT levels with structural and functional measures of heart disease and the extent to which these measures explain the relationship between hs-cTnT and secondary events.DesignWe measured serum concentrations of hs-cTnT and performed exercise treadmill testing with stress echocardiography in a prospective cohort study of outpatients with coronary heart disease who were enrolled from September 11, 2000, through December 20, 2002, and followed up for a median of 8.2 years.SettingTwelve outpatient clinics in the San Francisco Bay Area.ParticipantsNine hundred eighty-four patients with stable coronary heart disease.Main outcomes and measuresCardiovascular events (myocardial infarction, heart failure, or cardiovascular death), determined by review of medical records and death certificates.ResultsOf 984 participants, 794 (80.7%) had detectable hs-cTnT levels. At baseline, higher hs-cTnT levels were associated with greater inducible ischemia and worse left ventricular ejection fraction, left atrial function, diastolic function, left ventricular mass, and treadmill exercise capacity. During follow-up, 317 participants (32.2%) experienced a cardiovascular event. After adjustment for clinical risk factors, baseline cardiac structure and function, and other biomarkers (N-terminal portion of the prohormone of brain-type natriuretic peptide and C-reactive protein levels), each doubling in hs-cTnT level remained associated with a 37% higher rate of cardiovascular events (hazard ratio, 1.37 [95% CI, 1.14-1.65]; P = .001).Conclusions and relevanceIn outpatients with stable coronary heart disease, higher hs-cTnT levels were associated with multiple abnormalities of cardiac structure and function but remained independently predictive of secondary events. These findings suggest that hs-cTnT levels may detect an element of risk that is not captured by existing measures of cardiac disease severity.
- Published
- 2013