Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?

Romiti, Giulio Francesco; Cangemi, Roberto; Toriello, Filippo; Ruscio, Eleonora; Sciomer, Susanna; Moscucci, Federica; Vincenti, Marianna; Crescioli, Clara; Proietti, Marco; Basili, Stefania; Raparelli, Valeria

doi:10.1155/2019/9546931

Cited by 44 publications

(42 citation statements)

References 110 publications

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“…Presumably due to gender-specific differences in diagnoses and treatment and due to a higher rate of acute interventional need for therapy, more men were transferred to the catheterization laboratory or to the intensive care unit. The trend in male patients to be discharged directly from the CPU remains unclear but may be due to stricter rule-out parameters in men [35, 36]. The low in-CPU mortality without gender differences may be caused by good guideline adherence in certified German CPUs.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry

Settelmeier

Rassaf

Hochadel³

et al. 2020

Cardiology

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Introduction: Gender-specific atypical clinical presentation in acute coronary syndrome and sex-specific outcomes in cardiovascular disease in women are well known. The aim of this study is to analyze possible differences between men and women presenting to certified German chest pain units (CPUs). Methods: Data from 13,900 patients derived from the German CPU registry were analyzed for gender differences in patient characteristics, cardiovascular disease manifestation, critical time intervals, treatment and prognosis. Results: A total of 37.8% of patients were female. Typical chest pain occurred more frequently in men, while atypical symptoms occurred more frequently in women. Female gender was associated with longer pre-and in-hospital time delays. Women were more often diagnosed with a nonischemic origin of pain. In a 3-month follow-up, there was no gender-specific difference in combined major adverse coronary and cerebrovascular events. Discussion/Conclusion: This study points out gender-specific differences in prehospital time intervals and a significantly higher percentage of atypical symptoms in suspected myocardial ischemia as well as more noncoronary diagnoses in women. Symptom awareness and a broader diagnostic workup in women are essential.

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Section: Discussionmentioning

confidence: 99%

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry

Settelmeier

Rassaf

Hochadel³

et al. 2020

Cardiology

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“…In healthy individuals, circulating cTn levels are higher in men than women. 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.…”

Section: Cardiac Troponinsmentioning

confidence: 99%

“…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). [67][68][69] For example, in a study…”

Section: Cardiac Troponinsmentioning

confidence: 99%

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

Suthahar

Meems

et al. 2020

European J of Heart Fail

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The use of circulating biomarkers for heart failure (HF) is engrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However, biomarker profiles differ considerably among women and men. For instance, in the general population, markers of cardiac stretch (natriuretic peptides) and fibrosis (galectin‐3) are higher in women, whereas markers of cardiac injury (cardiac troponins) and inflammation (sST2) are higher in men. Such differences may reflect sex‐specific pathogenic processes associated with HF risk, but may also arise as a result of differences in sex hormone profiles and fat distribution. From a clinical perspective, sex‐related differences in biomarker levels may affect the objectivity of biomarkers in HF management because what is considered to be ‘normal’ in one sex may not be so in the other. The objectives of this review are, therefore: (i) to examine the sex‐specific dynamics of clinically relevant HF biomarkers in the general population, as well as in HF patients; (ii) to discuss the overlap between sex‐related and obesity‐related effects, and (iii) to identify knowledge gaps to stimulate research on sex‐related differences in HF.

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“…Moreover, the altered kinetics of cardiac troponins in renal insufficiency may give rise to clinical misinterpretation [ 13 ]. Furthermore, there is an increasing number of studies suggesting the use of gender-specific cutoffs for cTn [ 14 ]. There are differences in the 99th percentile URL between men and women in healthy reference populations.…”

Section: Introductionmentioning

confidence: 99%

Inconsistent Findings of Cardiac Troponin T and I in Clinical Routine Diagnostics: Factors of Influence

Eidizadeh¹,

Fraune²,

Leha

et al. 2021

JCM

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Cardiac troponins are crucial for the diagnosis of acute myocardial infarction. Despite known differences in their diagnostic implication, there are no recommendations for only one of the two troponins, cardiac troponin I (cTnI) and troponin T (cTnT) so far. In an everyday routine diagnostic, cTnT (Roche) as well as cTnI (Abbott) were measured in 5667 samples from 3264 patient cases. We investigated the number of identical or discrepant troponin findings. Regarding cTnI, we considered both, sex-dependent and unisex cutoffs. In particular, the number of cTnT positive and cTnI negative results was strikingly high in 14.0% of cTnT positive samples and increases to 23.8% by using sex-specific cTnI cutoffs. This group was considerably greater than the group of cTnI positive and cTnT negative results, also after elimination of patients with an eGFR < 60 mL/min/1.73 m2. Comparing the troponin cases with a dynamic increase or decrease between two measurements, we saw a balanced number of discrepant cases (between cTnT+/cTnI− and cTnT−/cTnI+), which was, however, still present. Using ROC analysis, sex-dependent cutoffs improved sensitivity and specificity of cTnI. This study shows in a large cohort that comparing the two cardiac troponins does not amount to identical analytical results. Consideration of sex-dependent cutoffs may improve sensitivity and specificity.

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Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?

Cited by 44 publications

References 110 publications

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry

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

Inconsistent Findings of Cardiac Troponin T and I in Clinical Routine Diagnostics: Factors of Influence

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