• Alexis L Beatty, Ivy A Ku, Robert H Christenson, Christopher R DeFilippi, Nelson B Schiller, and Mary A Whooley.
• Department of Medicine, University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121, USA.
• JAMA Intern Med. 2013 May 13;173(9):763-9.

ImportanceLevels of high-sensitivity cardiac troponin T (hs-cTnT) predict secondary cardiovascular events in patients with stable coronary heart disease.ObjectivesTo determine the association of hs-cTnT levels with structural and functional measures of heart disease and the extent to which these measures explain the relationship between hs-cTnT and secondary events.DesignWe measured serum concentrations of hs-cTnT and performed exercise treadmill testing with stress echocardiography in a prospective cohort study of outpatients with coronary heart disease who were enrolled from September 11, 2000, through December 20, 2002, and followed up for a median of 8.2 years.SettingTwelve outpatient clinics in the San Francisco Bay Area.ParticipantsNine hundred eighty-four patients with stable coronary heart disease.Main Outcomes And MeasuresCardiovascular events (myocardial infarction, heart failure, or cardiovascular death), determined by review of medical records and death certificates.ResultsOf 984 participants, 794 (80.7%) had detectable hs-cTnT levels. At baseline, higher hs-cTnT levels were associated with greater inducible ischemia and worse left ventricular ejection fraction, left atrial function, diastolic function, left ventricular mass, and treadmill exercise capacity. During follow-up, 317 participants (32.2%) experienced a cardiovascular event. After adjustment for clinical risk factors, baseline cardiac structure and function, and other biomarkers (N-terminal portion of the prohormone of brain-type natriuretic peptide and C-reactive protein levels), each doubling in hs-cTnT level remained associated with a 37% higher rate of cardiovascular events (hazard ratio, 1.37 [95% CI, 1.14-1.65]; P = .001).Conclusions And RelevanceIn outpatients with stable coronary heart disease, higher hs-cTnT levels were associated with multiple abnormalities of cardiac structure and function but remained independently predictive of secondary events. These findings suggest that hs-cTnT levels may detect an element of risk that is not captured by existing measures of cardiac disease severity.

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