Abstract 11934: High Sensitivity Cardiac Troponin T is Associated with Silent Cardiac Target Organ Damage in Asymptomatic Primary Prevention Patients
Background: Although, cTnT levels are rarely detectable in general population using standard assays, they are associated with overt cardiac disease. These findings suggest that cTnT detected by new highly sensitive assays may be useful in the detection of subclinical cardiac target organ damage (TOD) in a population of treated primary prevention patients. Hypothesis: In a population, of treated primary prevention patients, cTnT measured by high sensitivity assay can be used to identify silent cardiac TOD.
Methods: We prospectively recruited asymptomatic patients receiving primary preventive therapy. Each participant underwent a comprehensive echocardiographic examination, as per the American Society of Echocardiography guidelines, for the assessment of LV mass, LV systolic and diastolic function, and left atrial volume. Presence of inducible ischemia was assessed by dobutamine stress echocardiography or dypridamole myocardial perfusion imaging while cTnT levels were measured by high sensitivity assay.
Results: Out of 300 participants (Mean age 64±6, 58% males) 102 (34%) had evidence of cardiac TOD. Left ventricular hypertrophy was the most prevalent (29.7%) form of cardiac TOD followed by diastolic dysfunction (21.3%), left atrial enlargement (15.3%), systolic dysfunction (6.3%) and ischemia (6.3%). cTnT levels were significantly higher [median, (IQR) 5.91 (3.97-8.95) vs. 3.72 (3.00-5.93) ng/L, P<0.001] in those with cTOD compared to those without. In multivariate analysis, after correcting for age, gender, and eGFR, cTnT remained an independent predictor of underlying cTOD. A1-SD rise in logarithmically transformed cTnT was associated with an increased risk of existing cTOD [adjusted odds ratio 2.1 (95% CI 1.55-2.82)]. The AUC for cTnT to identify any form of cTOD was 0.70 (95% CI: 0.63-0.76, p<0.001) and an elevated cTnT above median (>4.0 ng/L) had a sensitivity of 75%, a specificity of 55% and a negative predictive value of 81%.
Conclusion: In asymptomatic patients requiring primary prevention, detectable cTnT levels, measured by high sensitivity assay, are associated with existing silent cardiac TOD of various subtypes. Using cTnT to identify silent cardiac TOD could, in the future, be harnessed to improve primary prevention.
- © 2011 by American Heart Association, Inc.