Revisited Upper Reference Limits for Highly Sensitive Cardiac Troponin T in Relation to Age, Sex, and Renal Function
Christiane Gärtner1, Romy Langhammer2, Maria Schmidt1
1Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center and Medical Faculty, 04109 Leipzig, Germany.
Insights
Age and sex significantly impact cardiac troponin T levels, necessitating adjusted reference values for accurate myocardial injury diagnosis. Current universal limits may not reflect these demographic differences.
Area of Science:
- Cardiology
- Clinical Chemistry
- Biomarker Research
Background:
- Highly sensitive cardiac troponin T (hs-cTnT) is crucial for diagnosing myocardial injury.
- Current hs-cTnT reference limits are generally applied universally, ignoring demographic factors.
- The impact of age, sex, and renal function on hs-cTnT requires further investigation.
Purpose of the Study:
- To determine age- and sex-adjusted upper reference limits for hs-cTnT.
- To evaluate the influence of renal function on hs-cTnT levels.
- To establish more precise reference values in a healthy population.
Main Methods:
- Analysis of 5428 subjects from the population-based LIFE-Adult cohort without cardiac disease.
- Calculation of sex- and age-adjusted 99th percentiles for hs-cTnT in individuals with preserved renal function.
- Assessment of hs-cTnT correlation with age, sex, and serum creatinine.
Main Results:
- hs-cTnT levels were higher in men across all age groups.
- Increasing age correlated positively with higher hs-cTnT values in both sexes.
- Renal function (serum creatinine) showed a weak correlation and no significant additional effect on hs-cTnT.
- Calculated 99th percentiles exceeded common thresholds in older men and women.
Conclusions:
- Age and sex are major determinants of serum hs-cTnT concentrations.
- Renal function does not significantly influence hs-cTnT levels.
- Age- and sex-adjusted reference values for hs-cTnT should be considered for improved diagnostic accuracy.
Abstract:
(1) Background: Highly sensitive cardiac troponin T (hs-cTnT) plays an essential role in the diagnosis of myocardial injury. The upper reference limit of the respective assay is generally applied, irrespective of age, renal function, or sex. We aimed to identify age-adjusted and sex-adjusted upper reference limits in relation to renal function in a large population-based cohort without cardiac diseases. (2) Methods: We included 5428 subjects of the population-based LIFE-Adult cohort, free of diagnosed cardiac diseases. Sex-adjusted and age-adjusted 99th percentiles for hs-cTnT in subjects with preserved renal function were obtained. (3) Results: The hs-cTnT values were higher in men of all age groups. In both sexes, an increasing age positively correlated with higher hs-cTnT values. Hs-cTnT weakly correlated with serum creatinine. The three-dimensional analysis of age, creatinine, and hs-cTnT showed no relevant additional effect of creatinine on hs-cTnT. In men aged above 60 and women above 70, the calculated 99th percentiles clearly exceeded the commonly applied thresholds. (4) Conclusion: Age and sex have a major impact on the serum concentration of hs-cTnT, while renal function does not. We propose to consider age-adjusted and sex-adjusted reference values.
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