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 individuals. Within normal range, higher levels are associated with coronary atherosclerotic 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 in spite of a low RF burden. H s-cTnT was measured in 525 stable patients without previous diagnosis of IHD with 0-1 RF, excluded diabetes, (Low-RF group, n=263) or ≥2 RFs (Multiple-RF group, n=262) and without CAD (segment involvement score, SIS=0) or diffuse CAD (SIS>5) at coronary computed tomography angiography. Outlier patients with diffuse CAD in spite of 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 (p6 ng/L) was independently associated with CAD in low-RF group only. D espite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse coronary atherosclerotic disease in spite of low RF burden.