title: Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients With Diffuse Coronary Atherosclerosis and Low-Risk Factors.
abstract: Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ≥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p <0.0001). Hs-cTnT was more accurate to detect patients with CAD in the low-RF group than in the multiple-RF group (p = 0.04). In multivariate analysis, higher level of hs-cTnT (>6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.
authors.affiliation: Heart Care Foundation Onlus, Florence, Italy. Electronic address: magnoni.marco@tiscali.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Magnoni
authors.affiliation: Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.affiliation: Centro Cardiologico Monzino, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Servizio di Ricerca Cardiovascolare, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: Department of Cardiology, Ospedale Policlinico, Modena, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.affiliation: Department of Cardiology, Santa Croce Hospital, Fano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Canestrari
authors.affiliation: Fondazione Toscana Gabriele Monasterio, Stabilimento di Massa, Unità Operativa Adult Cardiology, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Department of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Casolo
authors.affiliation: Department of Cardiology, Ospedale Civile A. Murri, Fermo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Gabrielli
authors.affiliation: Istituto di Fisiologia Clinica-Consiglio Nazionale delle Ricerche, Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marraccini
authors.affiliation: Centro Cardiologico Monzino, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Heart Care Foundation Onlus, Florence, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D002784:Cholesterol; D003404:Creatinine