Gender Specificities of Cardiac Troponin Serum Levels: From Formation Mechanisms to the Diagnostic Role in Case of Acute Coronary Syndrome

Abstract

Cardiac troponins T and I are the main (most sensitive and specific) laboratory indicators of myocardial cell damage. A combination of laboratory signs of myocardial cell damage (elevated levels of cardiac troponins T and I) with clinical (severe chest pain spreading to the left side of the human body) and functional (rise or depression of the ST segment, negative T wave or emergence of the Q wave according to electrocardiography and/or decrease in the contractility of myocardial areas exposed to ischemia according to echocardiography) signs of myocardial ischemia is indicative of the ischemic damage to cardiomyocytes, which is characteristic of the development of acute coronary syndrome (ACS). Today, with early diagnostic algorithms for ACS, doctors rely on the threshold levels of cardiac troponins (99th percentile) and on the dynamic changes in the serum levels over several hours (one, two, or three) from the moment of admission to the emergency department. That said, some recently approved highly sensitive methods for determining troponins T and I show variations in 99th percentile reference levels, depending on gender. To date, there are conflicting data on the role of gender specificities in the serum levels of cardiac troponins T and I in the diagnostics of ACS, and the specific mechanisms for the formation of gender differences in the serum levels of cardiac troponins T and I are unknown. The purpose of this article is to analyze the role of gender specificities in cardiac troponins T and I in the diagnostics of ACS, and to suggest the most likely mechanisms for the formation of differences in the serum levels of cardiac troponins in men and women.

Phenotypic variation of FXN compound heterozygotes in a Friedreich ataxia cohort

“…Chart review was performed to obtain the most recent troponin level, if available, as well as more detailed information on clinical and cardiac features in heterozygote patients. Troponin was considered elevated in low‐sensitivity assays at >0.03 ng/mL, and in high‐sensitivity assays at >20 ng/L for male and >15 ng/L for female sex, approximately based on 99th percentile ranges 28 . The most recent available study was used for echocardiogram, ECG, and Holter monitor data by chart review, excluding those measured in the setting of acute illness.…”

“…Troponin was considered elevated in low‐sensitivity assays at >0.03 ng/mL, and in high‐sensitivity assays at >20 ng/L for male and >15 ng/L for female sex, approximately based on 99th percentile ranges. 28 The most recent available study was used for echocardiogram, ECG, and Holter monitor data by chart review, excluding those measured in the setting of acute illness. The biplane assessment of ejection fraction (EF) was used, and the E/e′ ratio was averaged between the medial/septal and lateral measurements, when available.…”

Optimizing the Clinical Use of High-Sensitivity Troponin Assays: A Review

“…A recent cardiac magnetic resonance imaging (MRI) study reported a left ventricular mass of 39 g/m 2 for women and 50 g/m 2 for men [ 20 ]. Thus, the use of a single diagnostic threshold for cTn values in both men and women may result in the underdiagnosis of myocardial infarction in women and overdiagnosis in men [ 21 , 22 , 23 ]. This has led to the inclusion of sex-specific 99th-percentile URLs for hs-cTn in the universal definitions of myocardial infarction [ 4 ] and in the International Federation of Clinical Chemistry (IFCC) guidelines [ 24 , 25 ].…”