Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine. Action Points New, extremely sensitive assays for circulating troponin levels allow detection of low levels which may reflect chronic sources of myocardial injury and may predict long-term heart failure. This study found an association between low levels of troponin and HbA1c in individuals free of evident coronary heart disease and heart failure. A highly sensitive troponin test revealed evidence of subclinical heart damage in patients with hyperglycemia but no known coronary artery disease or heart failure, with particularly high enzyme levels in those with diabetes, according to a...