title: Determinants of high-sensitivity troponin T among patients with a noncardiac cause of chest pain.
abstract: BACKGROUND
  It is unknown to what extent noncardiac causes, including renal dysfunction, may contribute to high-sensitivity cardiac troponin T levels.
  
  
  METHODS
  In an observational international multicenter study, we enrolled consecutive patients presenting with acute chest pain to the emergency department. Of 1181 patients enrolled, 572 were adjudicated by 2 independent cardiologists to have a noncardiac cause of chest pain. Multiple linear regression analyses were used to determine the important predictors of log-transformed high-sensitivity cardiac troponin T. Kaplan-Meier curve was used to assess the prognostic significance of high-sensitivity cardiac troponin T>0.014 μg/L (99th percentile).
  
  
  RESULTS
  A total of 88 patients (15%) had high-sensitivity cardiac troponin T>0.014 μg/L. Less than 50% of cardiac troponins could be explained by known cardiac or noncardiac diseases. In decreasing order of importance, age, estimated glomerular filtration rate, hypertension, previous myocardial infarction, and chronic kidney disease (adjusted r(2) 0.44) emerged as significant factors in linear regression analysis to predict high-sensitivity cardiac troponin T. High-sensitivity cardiac troponin T was best explained by a linear curve with age as ≤0.014 μg/L. Patients with high-sensitivity cardiac troponin T levels>0.014 μg/L were at increased risk for all-cause mortality (hazard ratio 3.0; 95% confidence interval, 0.8-10.6; P=.02) during follow-up.
  
  
  CONCLUSIONS
  Among the known covariates, age and not renal dysfunction is the most important determinant of high-sensitivity cardiac troponin T. Because known cardiac and noncardiac factors, including renal dysfunction, explain less than 50% of high-sensitivity cardiac troponin T levels among patients with a noncardiac cause of chest pain, unknown or underestimated cardiac involvement during the acute presenting condition seems to be the major cause of elevated high-sensitivity cardiac troponin T.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland.
authors.forename: Affan
authors.initials: A
authors.lastname: Irfan
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Willibald
authors.initials: W
authors.lastname: Hochholzer
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Federico
authors.initials: F
authors.lastname: Peter
authors.forename: Isabel
authors.initials: I
authors.lastname: Campodarve
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000378:metabolism; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T