Utility of high-sensitivity cardiac troponin I normalized to left ventricular mass in detection of stable coronary artery disease

Abstract Coronary artery disease often develops silently before myocardial infarction, and current risk-based prevention pathways miss some individuals with clinically important disease, particularly those without standard modifiable cardiovascular risk factors. High-sensitivity cardiac troponin I is a blood biomarker of low-level myocardial injury, but its relationship to silent coronary atherosclerosis remains incompletely understood. Here we show, in 1,613 adults undergoing coronary computed tomography (CT) imaging, that low-level high-sensitivity cardiac troponin I is associated with clinically actionable coronary disease, defined by coronary calcium score ≥100, and with quantitative CT markers of plaque burden. A threshold of 2.3 ng l −1 enriched for actionable disease, especially in individuals without standard risk factors. Normalizing troponin for myocardial mass, age and renal function improved prediction and provided mechanistic insight into baseline troponin elevation in chronic coronary syndromes. A two-stage strategy using troponin before CT imaging increased diagnostic yield and reduced the number of scans required. Prospective validation is warranted before clinical implementation.

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Publication Details

Journal
Nature Cardiovascular Research
Published
2026-07-30
DOI
https://doi.org/10.1038/s44161-026-00837-z
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
Field-Weighted Citation Impact
0.00

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article

Utility of high-sensitivity cardiac troponin I normalized to left ventricular mass in detection of stable coronary artery disease

Philip Grieve, Katharine A. Bate, Gemma Alexandra Figtree, Michael P. Gray et al.
Nature Cardiovascular Research
Cardiac Imaging and Diagnostics
article

Utility of high-sensitivity cardiac troponin I normalized to left ventricular mass in detection of stable coronary artery disease

Philip Grieve, Katharine A. Bate, Gemma Alexandra Figtree, Michael P. Gray, David S. CELERMAJER, Collin Tran, Jean Yang, Louise Cullen, S. Fathieh, Owen Tang, DAVID R. SULLIVAN, Elijah Genetzakis, Soloman Saleh, Stephen T. Vernon, Jamil Mayet, Stephen J. Nicholls, Ravinay Bhindi, Paul Bonnitcha, Gillian Murtagh
article en

Abstract

Abstract Coronary artery disease often develops silently before myocardial infarction, and current risk-based prevention pathways miss some individuals with clinically important disease, particularly those without standard modifiable cardiovascular risk factors. High-sensitivity cardiac troponin I is a blood biomarker of low-level myocardial injury, but its relationship to silent coronary atherosclerosis remains incompletely understood. Here we show, in 1,613 adults undergoing coronary computed tomography (CT) imaging, that low-level high-sensitivity cardiac troponin I is associated with clinically actionable coronary disease, defined by coronary calcium score ≥100, and with quantitative CT markers of plaque burden. A threshold of 2.3 ng l −1 enriched for actionable disease, especially in individuals without standard risk factors. Normalizing troponin for myocardial mass, age and renal function improved prediction and provided mechanistic insight into baseline troponin elevation in chronic coronary syndromes. A two-stage strategy using troponin before CT imaging increased diagnostic yield and reduced the number of scans required. Prospective validation is warranted before clinical implementation.

Nature Cardiovascular Research
The University of Sydney (AU), New South Wales Department of Health (AU), Imperial College Healthcare NHS Trust (GB), Royal Brisbane and Women's Hospital (AU), Royal Prince Alfred Hospital (AU), Royal North Shore Hospital (AU), The Heart Research Institute (AU), UNSW Sydney (AU), University of Oxford (GB), St George Hospital (AU), Abbott Fund (US), National Health and Medical Research Council (AU), Imperial College London (GB), Monash University (AU)
Abbott Laboratories, University of Sydney, Abbott Diagnostics, National Health and Medical Research Council
Good health and well-being
Openalex Percentile: Top 10%
Cardiac Imaging and Diagnostics
DOIOpen Access PDFOpenAlex
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