AbstractBackgroundHigh‐sensitivity cardiac troponin T (hs‐cTnT) is a good prognostic marker for mortality. However, it is uncertain if hs‐cTnT can be used to detect sub‐clinical cardiac disease.MethodPilot study in patients without known heart disease and elevated hs‐cTnT measured at presentation to the emergency department. Hs‐cTnT was measure with Roche Diagnostics. Echocardiography was used to assess structural heart disease and the participants underwent computed tomography angiography for assessment of coronary artery disease and agatston score.ResultsTen patients were included in the final cohort. Median age was 68 years IQR (57‐78) and 80% were female (n = 8). Six patients had a history of chronic obstructive lung disease and five patients had history of hypertension. The median level of hs‐cTnT was 26 ng/L and values ranged from 19 ng/L to 495 ng/L. The median calcium score was 12. Three patients had signs of coronary artery disease. All patients had normal left ventricular ejection fraction with a median LVEF at 54.5%. Two patients were noted to have increased left ventricular mass index (LVMI).ConclusionThe majority of patients with hs‐cTnT above the 99th percentile did not have structural heart disease or ischaemic coronary disease. However, 30% of the patient did have signs of coronary disease and might benefit from preventive medical treatment. Measuring hs‐cTnT in the absence of acute illness might be a better approach for evaluation for sub‐clinical cardiac disease.