We have read with interest the Letter to the Editor by Velilla Moliner et al.1 concerning our article and appreciate their qualifications.
In contrast to diagnostic methods quantifying high-sensitivity troponin I, the methods used for high-sensitivity troponin T (hs-TnT) allow its detection in about 35% of the healthy population.2 Without delving into the definition of “healthy” and if the 99th percentile should vary according to the characteristics of the population being studied,3 this aspect has not undermined the usefulness of hs-TnT in both the diagnosis of acute coronary events and their exclusion (given its high negative predictive value4). In addition, as correctly highlighted by the authors, hs-TnT has shown prognostic value not only in heart disease populations, but also healthy populations.
The ideal biomarker would be useful for diagnosis and prognosis, as well as treatment-related aspects. Regarding the latter, hs-TnT is a marker of the effectiveness of the recommended treatment5 for heart failure.
The findings of the TUSARC (Troponina T UltraSensible en pacientes de muy Alto Riesgo Cardiovascular [High-sensitivity troponin T inpatients at high cardiovascular risk]) registry and others obligate clinicians to investigate other causes of hs-TnT elevation beyond ischemia. Thus, the association of an hs-TnT elevation with heart failure and myocardial fibrosis is important6 because it guides the role of elevated hs-TnT as a marker of both reversible and irreversible structural damage.
FUNDINGRoche Diagnostics provided the kits for the troponin determination, as well as both the internal and external controls.