The troponin protein complex plays a key role in the regulation of cardiac muscle contractions. Prolonged ischemia of the myocardium can lead to death of cardiomyocytes and release of intracellular proteins, such as troponins, into circulation. For this reason, Troponin T levels exceeding the 99th percentile of a normal reference population are designated as the decision level for the diagnosis of an MI in conjunction with that patient’s clinical presentation. The development of high-sensitivity assays allows for lower levels of cardiac troponins to be assessed for other etiologies. Literature shows that even minimal increases of troponin levels are associated with unfavorable cardiovascular and all-cause mortality outcomes. This association is also independent of conventional risk factors.
Troponin T, High Sensitivity (hs-TnT) is an independent prognostic marker that aids in the diagnosis of myocardial infarction (MI) in an acute setting (>22 ng/L for males and >14 ng/L for females), and there is literature supporting its use to assess relative risk for cardiovascular disease (CVD) and adverse cardiovascular events (≥6 ng/L for males and females).
- In a review of more than 154,000 patients in the general population, detectable troponin concentrations below the diagnostic threshold for myocardial infarction (MI) were associated with increased relative risk of CVD, as well as death secondary to CHD and stroke.
- Several trials, comprised of generally healthy individuals (ARIC, CHS, DHS, and MESA), demonstrate that any detectable level ≥6 ng/L confers increased relative risk for CVD.6-9
- hs-TnT levels can help identify and stratify disease severity in patients, without history of diagnosed CAD, presenting to the outpatient department with angina.
- In a meta-analysis of general population studies, elevated hs-TnT was strongly associated with an increased relative risk of cardiovascular and all-cause mortality.
- Increased hs-TnT within a 6-year follow-up was independently associated with incident CHD, death, and HF, while decreases were associated with reduced risk of the same outcomes.
- In patients with chronic heart failure, hs-TnT is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes.
References:
1. Katrukha IA. Human cardiac troponin complex. Structure and functions. Biochemistry Mosc. 2013;78(13):1447-1465.
2. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-2035.
3. Roche Diagnostics. Elecsys® Troponin T Gen 5 STAT. 2019-01, V 3.0.
4. Van der linden N, Klinkenberg LJ, Bekers O, et al. Prognostic value of basal highsensitive cardiac troponin levels on mortality in the general population: a meta-analysis. Medicine (Baltimore). 2016;95(52):e5703.
5. Willeit P, van Welsh P, Evans JDW, et al. High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants. J Am Coll Cardiol. 2017;70(5):558-568.
6. Oluleye OW, Folsom AR, Nambi V, et al. Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality. Ann Epidemiol. 2013;23(2):66-73.
7. deFilippi CR, de Lemos JA, Christenson RH, et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010;304(22):2494-2502.
8. de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304(22):2503-2512.
9. Seliger SL, Hong SN, Christenson RH, et al. High-sensitive cardiac troponin T as an early biochemical signature for clinical and subclinical heart failure: MESA (Multi-Ethnic Study of Atherosclerosis). Circulation. 2017;135(16):1494-1505.
10. Laufer EM, Mingels AM, Winkens MH, et al. The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T. Arterioscler Thromb Vasc Biol. 2010;30(6):1269-1275.
11. Mingels AM, Joosen IA, Versteylen MO, et al. High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort. PLoS ONE. 2012;7(4):e35059.
12. McEvoy JW, Chen Y, Ndumele CE, et al. Six-year change in high-sensitivity cardiac troponin T and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol. 2016;1(5):519-528.
13. Aimo A, Januzzi JL, Vergaro G, et al. Prognostic value of high-sensitivity troponin T in chronic heart failure: an individual patient data meta-analysis. Circulation. 2018;137(3):286-297.
14. Scherr J, Braun S, Schuster T, et al. 72-h kinetics of high-sensitive troponin T and inflammatory markers after marathon. Med Sci Sports Exerc. 2011;43(10):1819-1827.
15. Sedaghat-Hamedani F, Kayvanpour E, Frankenstein L, et al. Biomarker changes after strenuous exercise can mimic pulmonary embolism and cardiac injury--a metaanalysis of 45 studies. Clin Chem. 2015;61(10):1246-1255.
16. Nadruz W, Gonçalves A, Claggett B, et al. Influence of cigarette smoking on cardiac biomarkers: the Atherosclerosis Risk in Communities (ARIC) Study. Eur J Heart Fail. 2016;18(6):629-637.
17. Qamar A, Giugliano RP, Bohula EA, et al. Biomarkers and clinical cardiovascular outcomes with ezetimibe in the IMPROVE-IT trial. J Am Coll Cardiol. 2019;74(8):1057-1068.
18. Third report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). National Institutes of Health. September 2002. NIH Publication No. 02-5215.
19. Whelton SP, Mcevoy JW, Lazo M, Coresh J, Ballantyne CM, Selvin E. Highsensitivity cardiac troponin T (hs-cTnT) as a predictor of incident diabetes in the atherosclerosis risk in communities study. Diabetes Care. 2017;40(2):261-269.
20. American Diabetes Association: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Supplement 1).
21. McEvoy JW, Chen Y, Nambi V, et al. High-sensitivity cardiac troponin T and risk of hypertension. Circulation. 2015;132(9):825-833.
22. Neukamm AM, Høiseth AD, Hagve TA, Søyseth V, Omland T. High-sensitivity cardiac troponin T levels are increased in stable COPD. Heart. 2013;99(6):382-387.
23. Høiseth AD, Neukamm A, Karlsson BD, Omland T, Brekke PH, Søyseth V. Elevated high-sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2011;66(9):775- 781.
24. Yancy CW, Jessup M, Bozkurt B., et al. 217 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol. 2017; 70 (6): 776-803.
Keeping track of your medical data and laboratory results while understanding what they mean empowers positive health outcomes.
Keeping track of your medical data and lab results while understanding what they mean empowers positive health outcomes.
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A troponin test measures the level of troponin in your blood. Troponin is a type of protein found in the muscles of your heart. Troponin isn't normally found in the blood. When heart muscles become damaged, troponin is sent into the bloodstream. As heart damage increases, greater amounts of troponin are released in the blood.
Treatment Considerations:
(The treatment considerations are provided for informational purposes only and are not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.)
Assess level of exercise.
hs-TnT levels may be elevated in marathon runners and other athletes following strenuous exercise.
Assess smoking habits.
Smoking cessation is essential, as individuals who smoke are at increased risk of heart disease and blood clots.
Assess LDL-C levels.
If not at an optimal level, consider lipid-lowering therapies described in the National Cholesterol Education Program/Adult Treatment Panel III (NCEP ATP III) Guidelines.
Assess insulin sensitivity.
If not at an optimal level, consider insulin-sensitizing therapies described in the ADA guidelines for the management of pre-diabetes/diabetes.
Assess blood pressure.
If not at an optimal level, consider initiating, or titrating, antihypertensive therapy. Assess the presence of coronary artery disease (CAD) with imaging techniques such as carotid intima media thickness testing (CIMT) or coronary artery calcium (CAC) scoring.
Assess the presence of coronary artery disease (CAD) with imaging techniques such as carotid intima media thickness testing (CIMT) or coronary artery calcium (CAC) scoring.
Assess presence of chronic obstructive pulmonary disease (COPD).
COPD may lead to hypoxia and tachycardia, resulting in subclinical myocardial damage and hs-TnT elevations.
Assess for heart failure.
If heart failure is present or suspected, reference the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/ HFSA) guidelines for management of heart failure.
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