Use of high-sensitive cTn assays for the evaluation of patients potentially at risk for cardiovascular disease

Abstract

There is increasing interest in measurement of cardiac troponin (cTn) levels for assessment of subjects from the community. Given the low prevalence of cardiovascular (CV) disease, the utility of cTn as a screening tool in the general population however, is debated. Measurement of cTn levels might instead be clinically useful in selected at-risk cohorts. In fact, several studies have consistently demonstrated that cTn levels in these cohorts are strong predictors of adverse outcome, mainly with respect to mortality and the development of heart failure. cTn levels also provide prognostic value beyond that obtained from standard risk assessment including measurement of other circulating biomarkers and might thus, serve as an important component in primary prevention. In this chapter, we review the evidence on this topic including results from studies in selected at-risk cohorts, i.e. subjects with prevalent CV risk factors, diabetics and the elderly. The summarized notion from these investigations is that cTn measurements likely might serve as a ‘gatekeeper’ in the future, in particular to facilitate the identification of subjects with at-risk features in whom additional testing is needed to detect the particular source of cardiac injury and to design appropriate clinical responses.