Prevalence of Elevated High Sensitive Cardiac Troponin-T in Individuals with a Negative Stress test

Background: The exercise ECG stress test (EST) is still the first step of work-up in intermediate risk patients in many clinical scenarios. High sensitive cardiac troponin T (hs-cTnT) elevation is related to future cardiovascular events in the general population and in patients with ischemic heart disease. The relation between these two tests is not well described.

Methods: A total of 2,783 participants from the Tel-Aviv Medical Center Inflammation Survey cohort (mean age 49 years, 79% men) were analyzed. Multiple physiologic and metabolic parameters including high sensitive cardiac troponin T were collected. All participants completed an EST manually reviewed on the spot by a cardiologist.

Results: A Positive EST was documented in 224 subjects (8%). Cardiac troponin T concentrations were not significantly different between individuals with a negative and positive EST, 5.7 (4.1-7.8) vs. 6.2 (4.8-9.1) ng/L for median (IQR) respectively, p=0.07. The majority (91%) of participants with high sensitive cardiac troponin T levels of 5-13.9 ng/L had a negative EST as well as 89.3% of subjects with levels > 14 ng/L. The proportion of subjects with a positive EST and detectable hs-cTnT levels was non significantly greater compared to those with a negative EST (53.1% vs. 46.2% respectively, p=0.09).

Conclusion: Among subjects referred for EST as part of an annual health survey we found no significant association between EST results to hs-cTnT elevation.