title: Cardiomyocyte injury assessed by a highly sensitive troponin assay and sudden cardiac death in the community: the Cardiovascular Health Study.
abstract: OBJECTIVE
  This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD).
  
  
  BACKGROUND
  The pathophysiology of SCD is complex but is believed to be associated with an abnormal cardiac substrate in most cases. The association between biomarkers of cardiomyocyte injury in ambulatory subjects and SCD has not been investigated.
  
  
  METHODS
  Levels of cardiac troponin T, a biomarker of cardiomyocyte injury, were measured by a highly sensitive assay (hsTnT) in 4,431 ambulatory participants in the Cardiovascular Health Study, a longitudinal community-based prospective cohort study. Serial measures were obtained in 3,089 subjects. All deaths, including SCD, were adjudicated by a central events committee.
  
  
  RESULTS
  Over a median follow-up of 13.1 years, 246 participants had SCD. Baseline levels of hsTnT were significantly associated with SCD (hazard ratio [HR] for +1 log(hsTnT): 2.04, 95% confidence interval [CI]: 1.78 to 2.34]. This association persisted in covariate-adjusted Cox analyses accounting for baseline risk factors (HR: 1.30, 95% CI: 1.05 to 1.62), as well as for incident heart failure and myocardial infarction (HR: 1.26, 95% CI: 1.01 to 1.57). The population was also categorized into 3 groups based on baseline hsTnT levels and SCD risk [fully adjusted HR: 1.89 vs. 1.55 vs. 1 (reference group) for hsTnT ≥12.10 vs. 5.01 to 12.09 vs. ≤ 5.00 pg/ml, respectively; p trend = 0.005]. On serial measurements, change in hsTnT levels was also associated with SCD risk (fully adjusted HR for +1 pg/ml per year increase from baseline: 1.03, 95% CI: 1.01 to 1.06).
  
  
  CONCLUSIONS
  The findings suggest an association between cardiomyocyte injury in ambulatory subjects and SCD risk beyond that of traditional risk factors.
authors: Cardiology Division, University of Maryland, Baltimore, Maryland.
authors: Ayman A
authors: AA
authors: Hussein
authors: John S
authors: JS
authors: Gottdiener
authors: Traci M
authors: TM
authors: Bartz
authors: Nona
authors: N
authors: Sotoodehnia
authors: Christopher
authors: C
authors: deFilippi
authors: Timm
authors: T
authors: Dickfeld
authors: Rajat
authors: R
authors: Deo
authors: David
authors: D
authors: Siscovick
authors: Phyllis K
authors: PK
authors: Stein
authors: Donald
authors: D
authors: Lloyd-Jones
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood*; D016757:Death, Sudden, Cardiac / Q000473:pathology*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D032383:Myocytes, Cardiac / Q000473:pathology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: CI; HR; MI; SCD; cardiac troponin T levels by a highly sensitive assay; confidence interval(s); general population; hazard ratio(s); hsTnT; myocardial infarction; myocytes; sudden cardiac death; sudden death
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