Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay
M Odette Gore1, Stephen L Seliger2, Christopher R Defilippi2
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
The 99th percentile upper reference limit for high-sensitivity cardiac troponin T (hs-cTnT) varies significantly by age and sex. Current myocardial infarction cutoffs may lead to over-diagnosis in certain populations.
Area of Science:
- Cardiology
- Biomarker Research
- Population Health
Background:
- The current 14 ng/l cutoff for myocardial infarction diagnosis using high-sensitivity cardiac troponin T (hs-cTnT) is based on limited data.
- Existing cutoffs lack comprehensive characterization of healthy populations.
Purpose of the Study:
- To establish the 99th percentile upper reference limit for hs-cTnT in three large, independent cohorts.
- To investigate the influence of age, sex, and race on hs-cTnT levels.
Main Methods:
- Analysis of data from the Dallas Heart Study (DHS), Atherosclerosis Risk in Communities (ARIC) Study, and Cardiovascular Health Study (CHS).
- Definition of reference subcohorts excluding individuals with cardiovascular disease, kidney disease, or subclinical heart conditions.
- Stratified analysis by age, sex, and race.
Main Results:
- The 99th percentile hs-cTnT values varied across cohorts and between subcohorts (e.g., 18-36 ng/l in subcohort 1, 14-28 ng/l in subcohort 2).
- Values increased with age and were higher in men across all cohorts.
- Over 10% of men aged 65-74 without cardiovascular disease exceeded the current 14 ng/l threshold.
Conclusions:
- A uniform 14 ng/l cutoff for hs-cTnT may result in over-diagnosis of myocardial infarction, especially in elderly men.
- Age- and sex-specific cutoff values for hs-cTnT require clinical validation.
Objectives:
The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts.
Background:
The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization.
Methods:
Data were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race.
Results:
The 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14, 21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold.
Conclusions:
Use of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay.
More Related Videos
09:23Using Extraordinary Optical Transmission to Quantify Cardiac Biomarkers in Human Serum
Published on: December 13, 2017
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies