High-Sensitivity Cardiac Troponin and Coronary Heart Disease

High-Sensitivity Cardiac Troponin and Coronary Heart Disease

Current strategies for the assessment for coronary heart disease are imprecise with unacceptable consequences for many patients including prescription of unnecessary life-long therapies or failure to identify and treat those at greatest risk of myocardial infarction and death. Using complementary experimental, clinical and epidemiological approaches, this project is evaluating high-sensitivity cardiac troponin testing as a tool for precision medicine to improve the diagnosis, risk stratification, investigation, and treatment of patients with stable coronary heart disease.

This project will evaluate whether measuring a heart muscle protein, cardiac troponin, will help us to identify individuals with heart disease before they develop symptoms so that we can target treatments for the prevention of heart attacks more effectively. If successful cardiac troponin testing will be used as widely as cholesterol testing or the electrocardiogram in the diagnosis, treatment and prevention of heart disease.

This research includes patients with possible angina who underwent computed tomography-coronary angiography (CTCA) in the SCOT-HEART randomised controlled trial (Lancet. 2015;385:2383-91), and the Scottish Coronary Heart Disease Outcomes REgistry (SCORE) consisting of consecutive patients undergoing invasive coronary angiography at the Royal Infirmary of Edinburgh. Troponin concentrations are quantified using a series of established and research high-sensitivity assays. In our initial observations we demonstrate that high-sensitivity cardiac troponin can help us to target CTCA in patients with possible angina (Circ Cardiovasc Qual Outcomes. 2018;11(2):e004227, with online interactive clinical decision tool). Furthermore, serial cardiac troponin testing can help to predict future cardiovascular risk in those without symptoms, assess response to treatment, and identify those individuals who derive the greatest benefit from statin therapy (J Am Coll Cardiol. 2016;68:2719-28). Cardiac troponins can therefore dynamically track cardiovascular risk over time, and may be able to help us target preventative treatments more effectively.

Principal Investigator, Co-Investigators

The British Heart Foundation Cardiac Biomarker Laboratory is based in the Queen’s Medical Research Institute. The research group includes expertise in cardiology (Nicholas Mills), clinical biochemistry and immunoassays (Neil Johnstone), laboratory science (Takeshi Fujisawa, Edwin Carter), and clinical trials (Fiona Strachan). We participate in the UKNEQAS External Quality Assessment for Cardiac Biomarkers scheme and offer a range of cardiac biomarkers and clinical chemistry assays on an Abbott ARCHITECT ci4100 Integrated Analyser and Single Molecule Counting (SMC) Erenna® Analyser. We are supported by the British Heart Foundation Butler Senior Clinical Research Fellowship. Further information is available through our Twitter feed @highSTEACS or @troponinpapers.