High-Sensitivity Troponin T Concentrations in Acute Chest Pain Patients Evaluated With Cardiac Computed Tomography

Circulation. 2010; 121(3):1227-1234

Januzzi JL Jr, Bamberg F, Lee H, Truong QA, Nichols JH, Karakas M, Mohammed AA, Schlett CL, Nagurney JT, Hoffmann U, Koenig W

OBJECTIVES: For evaluation of patients with chest pain and suspected acute coronary syndrome (ACS), consensus guidelines recommend use of a cardiac troponin cut point that corresponds to the 99th percentile of a healthy population. Most conventional troponin methods lack sufficient precision at this low level.

METHODS: In a cross-sectional study, 377 patients (mean age 53.7 years, 64.2% male) with chest pain and low to intermediate likelihood for ACS were enrolled in the emergency department. Blood was tested with a precommercial high-sensitivity troponin T assay (hsTnT) and compared with a conventional cardiac troponin T method. Patients underwent a 64-slice coronary computed tomography coronary angiogram at the time of phlebotomy, on average 4 hours from initial presentation.

RESULTS: Among patients with acute chest pain, 37 (9.8%) had an ACS. Using the 99th percentile cut point for a healthy population (13 pg/mL), hsTnT had 62% sensitivity, 89% specificity, 38% positive predictive value, and 96% negative predictive value for ACS. Compared with the cardiac troponin T method, hsTnT detected 27% more ACS cases (P=.001), and an hsTnT above the 99th percentile strongly predicted ACS (odds ratio 9.0, 95% confidence interval 3.9 to 20.9, P<0.001). Independent of ACS diagnosis, computed tomography angiography demonstrated that concentrations of hsTnT were determined by numerous factors, including the presence and severity of coronary artery disease, left ventricular mass, left ventricular ejection fraction, and regional left ventricular dysfunction.

CONCLUSIONS: Among low- to intermediate-risk patients with chest pain, hsTnT provides good sensitivity and specificity for ACS. Elevation of hsTnT identifies patients with myocardial injury and significant structural heart disease, irrespective of the diagnosis of ACS.

PMID: 20194879

One Response

  1. Paul Schoenhagen, MD  on March 16th, 2010

    See editorial by:
    How Would the Reverend Bayes Interpret High-Sensitivity Troponin?
    George A. Diamond, MD; Sanjay Kaul, MD.
    Circulation. 2010;121:1172-1175.
    PMID: 20194887

    “The second noteworthy aspect of this study is the association of elevated hsTnT with prevalent cardiovascular disease as assessed by cardiac computed tomography. Nearly 11% (38 of 340) of patients without ACS also had elevations of hsTnT >13pg/mL. These patients were more likely to have risk factors or a previous history of CAD, a greater burden of CAD, larger cardiac chamber sizes, and greater left ventricular mass than were those without elevated hsTnT. This observation indicates that troponin, in addition to being a marker of ACS, might also be a marker of underlying structural heart disease, thereby supporting the use of hsTnT for cardiovascular screening. The mechanisms responsible for this association are unknown but might include silent myocardial ischemia, vascular inflammation, cardiomyocyte apoptosis, pressure and volume overload, and impairment of renal clearance.”


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