High-Sensitivity cardiac Troponins in Cardio-Healthy Subjects: A Cardiovascular Magnetic Resonance Imaging Study

Abstract

The 99th percentile upper reference limits (URL) of high-sensitivity cardiac troponin (hs-cTn) in healthy subjects are essential for diagnosis and management of cardiovascular diseases. Unless screened stringently, subclinical disease affects the derived URL. In 779 healthy subjects(49% males; 17–88 years) screened by cardiovascular magnetic resonance (CMR), the gold standard for assessing cardiac volumes and myocardial mass; and estimated glomerular filtration rate (eGFR), the 99th percentile URL of hsTnT (Roche) and hs-cTnI (Abbott) were similar to the published URL. The overall 99th percentile URL of hsTnT and hsTnI were 15.2 and 21.2 ng/L, respectively; males had higher values than females (hsTnT: 16.8 versus 11.9 ng/L and hsTnI: 38.8 versus 14.4 ng/L). Correlation between hsTnT and hsTnI was modest (r = 0.45; p < 0.001). A larger proportion of healthy volunteers <60 years had detectable hsTnI compared to hsTnT (n = 534; 30.0% versus 18.3%, p < 0.001). Lower eGFR was an independent clinical determinant of hsTnT, but not hsTnI. Both hs-cTn concentrations were independently associated with myocardial mass and cardiac volumes (p < 0.01 for all), but only hsTnI was independently associated with CMR multi-directional strain measures and extent of LV trabeculations (p < 0.05 for all). Differences exist between hs-cTn assays and may influence their selection depending on cardiac conditions, patient population and local factors.

Comparing conventional and high sensitivity troponin T measurements in identifying adverse cardiac events in patients admitted to an Asian emergency department chest pain observation unit

“…The optimal cut-off in our study population for hsTnT at 0 h to predict both 30 days and one year MACE is 16 ng/L( Table 1 ). This value is similar to the 99% URL of hsTnT reported in Singapore (15.2 ng/L) [20] . Substituting 15 ng/L as the cut-off value for 0 and 2 h hsTnT instead of 16 ng/L identified the same number of true positives for 30-day and 1-year MACE, but also inaccurately categorized 9 more false positives for 30-day and 1-year MACE as compared to the 16 ng/L cut-off ( Table 2 ).…”

Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future

“…Risk assessment is a separate issue and hs-Tn is used in this assessment. Importantly, interpretation of cTn levels should not be performed in isolation of clinical context, but with careful clinical evaluation in emergencies such as potential acute MI because cTn levels can be detected in apparently healthy populations, especially when measured by high-sensitivity methods [ 56 , 57 ]. Notably, triggers of cTn leakage not related to irreversible cardiomyocyte necrosis can include elevated troponin after prolonged physical activity, inducible MI, and prolonged episodes of tachyarrhythmia, even in presumably healthy individuals [ 58 , 59 ].…”

Sex‐related differences in contemporary biomarkers for heart failure: a review

“…127,128 For instance, median values were ∼53% higher in men using the Roche Diagnostics cTnT assay [pooled median values ± standard deviation (SD): 5.5 ± 2.2 ng/L in men vs. 3.6 ± 1.3 ng/L in women], [60][61][62][63][64] and ∼44% higher in men with the Abbott cTnI assay (2.6 ± 1.1 ng/L in men vs. 1.8 ± 1.0 ng/L in women). 60,62,65 An illustrative overview of sex-related differences in the 99th percentile values for cTnT assay (Roche Diagnostics) and cTnI assays (Abbott Diagnostics, Beckman Coulter, Singulex and Siemens) using data from over 30 population-based studies was recently provided by Romiti and colleagues. 128 In HF patients, plasma cTn levels rise several fold ( Figure 3A), 66,129,130 and on average, men have higher cTn levels compared with women ( Figure 3B).…”