Published online before print April 17, 2006, doi: 10.1161/CIRCULATIONAHA.105.609974
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(Circulation. 2006;113:1958-1965.)
© 2006 American Heart Association, Inc.
Epidemiology |
Prevalence and Determinants of Troponin T Elevation in the General Population
From the Donald W. Reynolds Cardiovascular Clinical Research Center and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (T.W.W., S.M.A., M.H.D., S.R.D., A.K., D.K.M., F.W., J.A.d.L.); and Donald W. Reynolds Cardiovascular Clinical Research Center, Brigham and Women’s Hospital, Boston, Mass (M.S.S., D.A.M.).
Correspondence to James A. de Lemos, MD, Division of Cardiology, University of Texas Southwestern Medical Center, 5909 Harry Hines Blvd, Room HA9.133, Dallas, TX 75390-9047. E-mail James.delemos{at}utsouthwestern.edu
Received November 7, 2005; de novo received December 21, 2005; revision received February 21, 2006; accepted February 23, 2006.
Background— The prevalence and determinants of cardiac troponin T (cTnT) elevation in the general population are unknown, and the significance of minimally increased cTnT remains controversial. Our objective was to determine the prevalence and determinants of cTnT elevation in a large, representative sample of the general population.
Methods and Results— cTnT was measured from stored plasma samples in 3557 subjects of the Dallas Heart Study, a population-based sample. cTnT elevation (
0.01 µg/L) was correlated with clinical variables and cardiac MRI findings. The sample weight-adjusted prevalence of cTnT elevation in the general population was 0.7%. In univariable analyses, cTnT elevation was associated with older age, black race, male sex, coronary artery calcium by electron beam CT, a composite marker of congestive heart failure (CHF), left ventricular hypertrophy (LVH), diabetes mellitus (DM), and chronic kidney disease (CKD) (P<0.001 for each). Subjects with minimally increased (0.01 to 0.029 µg/L) and increased (0.03 µg/L) cTnT had a similar prevalence of these characteristics. In multivariable logistic regression analysis, LVH, CHF, DM, and CKD were independently associated with cTnT elevation.
Conclusions— In the general population, cTnT elevation is rare in subjects without CHF, LVH, CKD, or DM, suggesting that the upper limit of normal for the immunoassay should be <0.01 µg/L. Even minimally increased cTnT may represent subclinical cardiac injury and have important clinical implications, a hypothesis that should be tested in longitudinal outcome studies.
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