Any Detectable High-Sensitivity Cardiac Troponin T Level Associated With Adverse Outcomes Interview with:
Martin Holzmann PhD

Department of Medicine
Functional Area of Emergency Medicine,
Karolinska University Hospital, Huddinge
Stockholm, Sweden What is the background for this study? What are the main findings?

Response: There has been a few studies in the general population that indicate that subjects with detectable and elevated high-sensitivity troponin T (hs-cTnT) levels have an increased risk of death and cardiovascular disease. However, in clinical practice troponins are not used for anything else than to rule in or rule out myocardial infarction in the emergency department. In addition, in a previous publication we have shown that patients with persistently elevated troponin levels are rarely investigated or followed-up to exclude heart disease. Therefore, we wanted to investigate how the association between different levels of hs-cTnT are associated with outcomes in patients with chest pain but no MI or other acute reasons for having an acutely elevated troponin level.

The main finding was that hs-cTnT levels even regarded as completely normal are associated with an increased mortality, cardiovascular death, heart failure, and myocardial infarction. The association was graded and there was an increased risk with increasing levels of hs-cTnT. The “true” normal, or maybe we should call it optimal level of hs-cTnT is <5 ng/l, meaning that they are undetectable. 62% had levels <5 ng/l, meaning that as many as 38% of our study population were exposed to detectable hs-cTnT levels. Another important thing to mention is that the association between increasing levels of hs-cTnT and adverse outcome is found for all subgroups of patients: younger, elderly; men, women; patients with or without heart disease, chronic kidney disease, atrial fibrillation, reasons which commonly are used as an explanation for the finding of an elevated troponin level. Therefore, clinicians should not “blame” elevated troponin levels on kidney disease, high age or other comorbidities, but understand that no matter who you are, an elevated troponin level is “bad” to have. What should clinicians and patients take away from your report?

Response: See above under main findings:

  1. Any detectable hs-cTnT level is associated with adverse outcome.
  2. This is true for all patients no matter what comorbidities the patient has. What recommendations do you have for future research as a result of this study?

Response: We need to conduct randomized controlled trials where we try to understand how to treat patients with elevated troponin levels and no underlying heart disease. My strong belief is that these patients will benefit from a multifactorial intervention with high-intensity statins, ACE-inhibitors, and maybe platelet inhibitors, and a strict blood pressure control of course.  

Disclosures: I received honoraria from Actelion and Pfizer Thank you for your contribution to the community.


Stable High-Sensitivity Cardiac Troponin T Levels and Outcomes in Patients With Chest Pain

Journal of the American College of Cardiology

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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