Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study

Abstract

Interest in high-sensitivity cardiac troponin I(hs-cTnI) and T(hs-cTnT) has expanded from acute cardiac care to cardiovascular disease(CVD) risk stratification. Whether hs-cTnI and hs-cTnT are interchangeable in the ambulant setting is largely unexplored. Cardiac injury is a mechanism that may underlie the associations between troponin levels and mortality in the general population. In the population-based Maastricht Study, we assessed the correlation and concordance between hs-cTnI and hs-cTnT. Multiple regression analyses were conducted to assess the association of hs-cTnI and hs-cTnT with electrocardiographic (ECG) changes indicative of cardiac abnormalities. In 3016 eligible individuals(mean age,60 ± 8years;50.6%,men) we found a modest correlation between hs-cTnI and hs-cTnT(r = 0.585). After multiple adjustment, the association with ECG changes indicative of cardiac abnormalities was similar for both hs-cTn assays(OR,hs-cTnI:1.72,95%CI:1.40-2.10;OR,hs-cTnT:1.60,95%CI:1.22–2.11). The concordance of dichotomized hs-cTnI and hs-cTnT was κ = 0.397(≥sex-specific 75th percentile). Isolated high levels of hs-cTnI were associated with ECG changes indicative of cardiac abnormalities(OR:1.93,95%CI:1.01–3.68), whereas isolated high levels of hs-cTnT were not(OR:1.07,95%CI:0.49–2.31). In conclusion, there is a moderate correlation and limited concordance between hs-cTnI and hs-cTnT under non-acute conditions. These data suggest that associations of hs-cTnI and hs-cTnT with cardiac injury detected by ECG are driven by different mechanisms. This information may benefit future development of CVD risk stratification algorithms.

High-Sensitivity cardiac Troponins in Cardio-Healthy Subjects: A Cardiovascular Magnetic Resonance Imaging Study

“…Recent publications 47 , 48 have shown that the nonparametric approach in combination with a conservative treatment of outliers is the preferred method for determination of the 99 th percentile URL for hs-cTn. The 99 th percentile values were determined by 1-tailed non-parametric statistics according to CLSI guidelines 49 – 51 with no exclusion of outliers. Continuous variables were assessed for normal distribution using the Shapiro-Wilk test.…”

High-Sensitivity Troponin I and Incident Coronary Events, Stroke, Heart Failure Hospitalization, and Mortality in the ARIC Study

“…31,32 However, our finding is consistent with studies in individuals without known coronary artery disease and even those with stable disease. 4,33,34 Biological etiologies for observed differences between hs-TnI and hs-TnT may reflect distinctions in structure, kinetics, and clearance. 33,[35][36][37][38][39][40] We found that individuals with high hs-TnI but lower hs-TnT levels, when compared with those with lower hs-TnI and high hs-TnT, had more high-risk features, including hypertension, hyperlipidemia, smoking, and left ventricular hypertrophy, but had better renal function.…”

Effect of Acute Coronary Syndrome Probability on Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin

“…The most likely explanation for this finding therefore is the biological non-equivalence of 26 ng/L for hs-cTnI versus 14ng/L for hs-cTnT as previously documented in two large studies (15,16). The biological equivalent hs-cTnI concentration corresponding to the 99 th percentile for hs-cTnT was about half the approved 99 th percentile for hs-cTnI in these studies (15,16). This major discrepancy in the currently recommended 99 th -percentiles became also evident in this dataset: diagnostic accuracies for NSTEMI provided by early absolute changes of hs-cTn within 1-hour, alone or in combination with hs-cTn concentrations at presentation, provided very high and similar diagnostic accuracy in patients with low ACSprobability as compared to the other strata.…”

“…At first glance, this is surprising as both assays seem to have comparable diagnostic accuracy for AMI (14), and hs-cTnI seems to have even higher analytical sensitivity as compared to hs-cTnT (11). The most likely explanation for this finding therefore is the biological non-equivalence of 26 ng/L for hs-cTnI versus 14ng/L for hs-cTnT as previously documented in two large studies (15,16). The biological equivalent hs-cTnI concentration corresponding to the 99 th percentile for hs-cTnT was about half the approved 99 th percentile for hs-cTnI in these studies (15,16).…”