Prognostic Value of High-Sensitivity Cardiac Troponin in Women

Abstract

High-sensitivity cardiac troponin assays have become the gold standard for diagnosing acute and chronic myocardial injury. The detection of troponin levels beyond the 99th percentile is included in the fourth universal definition of myocardial infarction, specifically recommending the use of sex-specific thresholds. Measurable concentrations below the proposed diagnostic thresholds have been shown to inform prognosis in different categories of inpatients and outpatients. However, clinical investigations from the last twenty years have yielded conflicting results regarding the incremental value of using different cut-offs for men and women. While advocates of a sex-specific approach claim it may help reduce gender bias in cardiovascular medicine, particularly in acute coronary syndromes, other groups question the alleged incremental diagnostic and prognostic value of sex-specific thresholds, ultimately asserting that less is more. In the present review, we aimed to synthesize our current understanding of sex-based differences in cardiac troponin levels and to reappraise the available evidence with regard to (i) the prognostic significance of sex-specific diagnostic thresholds of high-sensitivity cardiac troponin assays compared to common cut-offs in both men and women undergoing cardiovascular disease risk assessment, and (ii) the clinical utility of high-sensitivity cardiac troponin assays for cardiovascular disease prevention in women.

Biomolecules and Cardiovascular Diseases in Women

“…High-sensitivity cardiac troponin assays have become gold standard for diagnosing acute and chronic myocardial injury; however, clinical investigations still debate on the use of different cut-offs for men and women [ 14 , 15 ]. Bisaccia and colleagues [ 16 ] deeply reviewed the pivotal role of cardiac troponin as a prognostic marker of disease. Sex-based differences in cardiac troponin levels are further explored, with regard to the prognostic significance of sex-specific diagnostic thresholds of high-sensitivity cardiac troponin assays versus common cut-offs in men and women undergoing CVD risk assessment, and to the clinical utility of high-sensitivity cardiac troponin assays for CV disease prevention in women.…”