Predictors of high-sensitivity cardiac troponin in stable patients undergoing coronary angiography
Christian M Valina1, Michael Amann, Christian Stratz
1University Heart Center Freiburg - Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany.
Insights
Elevated cardiac troponin levels are common in stable patients undergoing elective coronary assessment. Key factors influencing these levels include gender, renal function, age, and heart function, highlighting the multifactorial nature of troponin elevation.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Diagnostics
Background:
- Elevated high-sensitivity troponin T (hsTnT) is frequently observed in stable patients undergoing elective coronary assessment.
- Numerous clinical, laboratory, and imaging variables have been linked to troponin levels.
Purpose of the Study:
- To identify variables independently associated with elevated troponin levels in stable patients.
- To determine the relative strength of association of these variables with troponin levels.
Main Methods:
- Analysis of 2,046 stable patients undergoing elective coronary angiography and echocardiography.
- Measurement of high-sensitivity troponin T (hsTnT) prior to procedures.
- Application of multivariable linear regression models incorporating angiographic and echocardiographic parameters.
Main Results:
- 15% of patients exhibited troponin levels above the normal reference limit.
- Gender, renal function, age, left ventricular ejection fraction, diabetes, and left ventricular mass were the strongest independent predictors of troponin levels.
- Coronary obstruction was also a predictor, though its association strength diminished after adjustment.
Conclusions:
- A significant proportion of stable patients (up to 15%) present with elevated cardiac troponin outside acute coronary syndromes.
- These troponin elevations are independently associated with a combination of clinical, laboratory, and imaging factors.
Aims:
Elevated levels of high-sensitivity troponin are seen in a significant proportion of stable patients undergoing elective coronary assessment. Multiple variables have been associated with troponin levels. The present analysis sought to identify variables independently associated with elevations of troponin and their relative strength of association with this biomarker.
Methods And Results:
Stable patients undergoing elective coronary angiography and echocardiographic assessment were enrolled. High-sensitivity troponin T (hsTnT) was determined before any diagnostic procedures. Multivariable linear regression models including angiographic and echocardiographic parameters were used to identify independent predictors of levels of troponin and to determine their relative contribution to levels of troponin. Out of 2,046 patients, 15% presented with levels of troponin above the upper reference limit of normal. In a combined analysis, gender followed by renal function, age, left ventricular ejection fraction, diabetes, and left ventricular mass showed the strongest association with levels of troponin. Coronary obstruction was also an independent predictor, but strength of association weakened following adjustment.
Conclusions:
Up to 15% of patients undergoing coronary assessment outside the setting of acute coronary syndromes present with elevated levels of cardiac troponin. These changes are independently associated with multiple clinical, laboratory, and imaging variables.
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