High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography

Area of Science:

• Cardiology
• Biomarker Discovery
• Emergency Medicine

Background:

• Current guidelines recommend cardiac troponin testing at the 99th percentile for acute coronary syndrome (ACS) evaluation.
• Conventional troponin assays often lack the necessary precision at these low diagnostic levels.

Purpose of the Study:

• To evaluate the performance of a high-sensitivity troponin T (hsTnT) assay in patients presenting with chest pain.
• To compare hsTnT with conventional troponin T methods for ACS detection.
• To explore the relationship between hsTnT levels and cardiac structure/function.

Main Methods:

• A cross-sectional study enrolled 377 patients with chest pain and low-to-intermediate ACS likelihood.
• Blood samples were analyzed using a precommercial hsTnT assay and a conventional troponin T method.
• Patients also underwent coronary computed tomography angiography (CCTA) for cardiac assessment.

Main Results:

• The hsTnT assay demonstrated 62% sensitivity and 89% specificity for ACS at the 99th percentile cut point (13 pg/mL).
• hsTnT detected 27% more ACS cases than the conventional method (P=.001).
• Elevated hsTnT strongly predicted ACS (OR 9.0) and correlated with coronary artery disease severity and left ventricular abnormalities.

Conclusions:

• hsTnT assays provide good sensitivity and specificity for diagnosing ACS in patients with chest pain.
• Elevated hsTnT levels are indicative of myocardial injury and significant structural heart disease, regardless of ACS diagnosis.