Association of troponin T detectedwith a highly sensitive assay and cardiac structure and mortality risk in the general population

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Abstract

Context: Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. Objectives: To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Design, Setting, and Participants: Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Main Outcome Measures: Magnetic resonance imaging measurements of cardiac structure and function and mortality through amedian of 6.4 (interquartile range, 6.0-6.8) years of follow-up. Results: In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%-27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%-1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%-41.0%) in men vs 12.9% (95% CI, 10.6%-15.2%) in women and 14.0% (95% CI, 11.2%-16.9%) in participants younger than 40 years vs 57.6% (95% CI, 47.0%-68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%-8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%-59.6%) in the highest (≥0.014 ng/mL) (P<.001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P<.001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%-2.6%) to 28.4% (95% CI, 21.0%-37.8%) across higher cTnT categories (P<.001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P=.02) and the integrated discrimination index (0.010 [95% CI, 0.002-0.018]; P=.01). Conclusion: In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

Original languageEnglish (US)
Pages (from-to)2503-2512
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume304
Issue number22
DOIs
StatePublished - Dec 8 2010

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Troponin T
Confidence Intervals
Mortality
Population
Chronic Renal Insufficiency
Heart Diseases
Brain Natriuretic Peptide
Left Ventricular Dysfunction
Left Ventricular Hypertrophy
C-Reactive Protein
Cohort Studies
Cardiovascular Diseases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{54f089893ba6454aac97d422f41d3b3d,
title = "Association of troponin T detectedwith a highly sensitive assay and cardiac structure and mortality risk in the general population",
abstract = "Context: Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. Objectives: To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Design, Setting, and Participants: Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Main Outcome Measures: Magnetic resonance imaging measurements of cardiac structure and function and mortality through amedian of 6.4 (interquartile range, 6.0-6.8) years of follow-up. Results: In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0{\%} (95{\%} confidence interval [CI], 22.7{\%}-27.4{\%}) with the highly sensitive assay vs 0.7{\%} (95{\%} CI, 0.3{\%}-1.1{\%}) with the standard assay. Prevalence was 37.1{\%} (95{\%} CI, 33.3{\%}-41.0{\%}) in men vs 12.9{\%} (95{\%} CI, 10.6{\%}-15.2{\%}) in women and 14.0{\%} (95{\%} CI, 11.2{\%}-16.9{\%}) in participants younger than 40 years vs 57.6{\%} (95{\%} CI, 47.0{\%}-68.2{\%}) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5{\%} (95{\%} CI, 6.4{\%}-8.8{\%}) in the lowest cTnT category (<0.003 ng/mL) to 48.1{\%} (95{\%} CI, 36.7{\%}-59.6{\%}) in the highest (≥0.014 ng/mL) (P<.001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P<.001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9{\%} (95{\%} CI, 1.5{\%}-2.6{\%}) to 28.4{\%} (95{\%} CI, 21.0{\%}-37.8{\%}) across higher cTnT categories (P<.001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95{\%} CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P=.02) and the integrated discrimination index (0.010 [95{\%} CI, 0.002-0.018]; P=.01). Conclusion: In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.",
author = "{de Lemos}, {James A} and Drazner, {Mark H} and Torbjorn Omland and Ayers, {Colby R.} and Amit Khera and Rohatgi, {Anand K} and Hashim, {Ibrahim A} and Berry, {Jarett D} and Das, {Sandeep R} and Morrow, {David A.} and McGuire, {Darren K}",
year = "2010",
month = "12",
day = "8",
doi = "10.1001/jama.2010.1768",
language = "English (US)",
volume = "304",
pages = "2503--2512",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "22",

}

TY - JOUR

T1 - Association of troponin T detectedwith a highly sensitive assay and cardiac structure and mortality risk in the general population

AU - de Lemos, James A

AU - Drazner, Mark H

AU - Omland, Torbjorn

AU - Ayers, Colby R.

AU - Khera, Amit

AU - Rohatgi, Anand K

AU - Hashim, Ibrahim A

AU - Berry, Jarett D

AU - Das, Sandeep R

AU - Morrow, David A.

AU - McGuire, Darren K

PY - 2010/12/8

Y1 - 2010/12/8

N2 - Context: Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. Objectives: To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Design, Setting, and Participants: Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Main Outcome Measures: Magnetic resonance imaging measurements of cardiac structure and function and mortality through amedian of 6.4 (interquartile range, 6.0-6.8) years of follow-up. Results: In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%-27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%-1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%-41.0%) in men vs 12.9% (95% CI, 10.6%-15.2%) in women and 14.0% (95% CI, 11.2%-16.9%) in participants younger than 40 years vs 57.6% (95% CI, 47.0%-68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%-8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%-59.6%) in the highest (≥0.014 ng/mL) (P<.001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P<.001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%-2.6%) to 28.4% (95% CI, 21.0%-37.8%) across higher cTnT categories (P<.001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P=.02) and the integrated discrimination index (0.010 [95% CI, 0.002-0.018]; P=.01). Conclusion: In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

AB - Context: Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. Objectives: To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Design, Setting, and Participants: Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Main Outcome Measures: Magnetic resonance imaging measurements of cardiac structure and function and mortality through amedian of 6.4 (interquartile range, 6.0-6.8) years of follow-up. Results: In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%-27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%-1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%-41.0%) in men vs 12.9% (95% CI, 10.6%-15.2%) in women and 14.0% (95% CI, 11.2%-16.9%) in participants younger than 40 years vs 57.6% (95% CI, 47.0%-68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%-8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%-59.6%) in the highest (≥0.014 ng/mL) (P<.001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P<.001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%-2.6%) to 28.4% (95% CI, 21.0%-37.8%) across higher cTnT categories (P<.001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P=.02) and the integrated discrimination index (0.010 [95% CI, 0.002-0.018]; P=.01). Conclusion: In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

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