Clinical determinants of plasma cardiac biomarkers in patients with stable chest pain

Heart. 2019 Nov;105(22):1748-1754. doi: 10.1136/heartjnl-2019-314892. Epub 2019 Jun 1.


Objective: Troponin and B-type natriuretic peptide (BNP) concentrations are associated with cardiovascular risk in stable patients. Understanding their determinants and identifying modifiable clinical targets may improve outcomes. We aimed to establish clinical and cardiac determinants of these biomarkers.

Methods: This was a prespecified substudy from the randomised Scottish Computed Tomography of the Heart trial, which enrolled patients 18-75 years with suspected stable angina between 2010 and 2014 (NCT01149590). We included patients from six centres in whom high-sensitivity troponin I and BNP were measured (Singulex Erenna). Patients with troponin >99th centile upper reference limit (10.2 ng/L) or BNP ≥400 ng/L were excluded to avoid inclusion of patients with myocardial injury or heart failure. Multivariable linear regression models were constructed with troponin and BNP as dependent variables.

Results: In total, 885 patients were included; 881 (99%) and 847 (96%) had troponin and BNP concentrations above the limit of detection, respectively. Participants had a slight male preponderance (n=513; 56.1%), and the median age was 59.0 (IQR 51.0-65.0) years. The median troponin and BNP concentrations were 1.4 (IQR 0.90-2.1) ng/L and 29.1 (IQR 14.0-54.0) ng/L, respectively. Age and atherosclerotic burden were independent predictors of both biomarkers. Male sex, left ventricular mass and systolic blood pressure were independent predictors of increased troponin. In contrast, female sex and left ventricular volume were independent predictors of increased BNP.

Conclusions: Troponin and BNP are associated with coronary atherosclerosis but have important sex differences and distinct and contrasting associations with CT-determined left ventricular mass and volume.

Clinical trial registration: NCT01149590; Post-results.

Keywords: B-type natriuretic peptide; cardiac biomarkers; computed tomography coronary angiography; coronary artery disease; troponin.

Publication types

  • Multicenter Study
  • Pragmatic Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angina, Stable / blood*
  • Angina, Stable / diagnostic imaging
  • Angina, Stable / therapy
  • Biomarkers / blood
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Predictive Value of Tests
  • Prognosis
  • Severity of Illness Index
  • Sex Factors
  • Troponin I / blood*
  • Up-Regulation
  • Young Adult


  • Biomarkers
  • Troponin I
  • Natriuretic Peptide, Brain

Associated data