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A sensitive cardiac troponin T assay in stable coronary artery disease
Torbjørn Omland1, James A de Lemos, Marc S Sabatine
1Division of Medicine, Akershus University Hospital, Lørenskog, Norway. torbjorn.omland@medisin.uio.no
Insights
High-sensitivity troponin T assays reveal that elevated levels, even below conventional detection limits, strongly predict cardiovascular death and heart failure in stable coronary artery disease patients. Myocardial infarction risk was not associated.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Diagnostics
Background:
- Stable coronary artery disease (CAD) patients typically have cardiac troponin T (cTnT) below conventional assay detection limits.
- The clinical significance of very low cTnT levels in stable CAD is not well understood.
Purpose of the Study:
- To investigate the distribution and determinants of very low cTnT levels in stable CAD.
- To assess the association of these levels with cardiovascular events using a high-sensitivity assay.
Main Methods:
- A high-sensitivity assay measured plasma cTnT in 3679 stable CAD patients with preserved left ventricular function.
- Patients were followed for a median of 5.2 years for cardiovascular events.
Main Results:
- 97.7% of patients had detectable cTnT, and 11.1% exceeded the 99th percentile of healthy subjects.
- Elevated cTnT levels showed a graded association with increased risk of cardiovascular death (aHR 2.09) and heart failure (aHR 2.20).
- This association was observed even below conventional assay detection limits and the healthy population's 99th percentile; no association with myocardial infarction was found.
Conclusions:
- High-sensitivity cTnT measurements are significantly associated with cardiovascular death and heart failure in stable CAD.
- These findings highlight the prognostic value of cTnT at concentrations previously considered undetectable.
- The assay did not show a significant association with myocardial infarction incidence in this cohort.
Background:
In most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown.
Methods:
We used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years.
Results:
With the highly sensitive assay, concentrations of cardiac troponin T were at or above the limit of detection (0.001 microg per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 microg per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group. Increased risk associated with higher levels of troponin T was evident well below the limit of detection of conventional cardiac troponin T assays and below the 99th percentile of values in a healthy population. There was no association between troponin T levels as measured with the highly sensitive assay and the incidence of myocardial infarction (adjusted hazard ratio, 1.16; 95% CI, 0.97 to 1.40; P=0.11).
Conclusions:
After adjustment for other independent prognostic indicators, cardiac troponin T concentrations as measured with a highly sensitive assay were significantly associated with the incidence of cardiovascular death and heart failure but not with myocardial infarction in patients with stable coronary artery disease.
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