Abstract
Introduction: Hs-cTnI and hs-cTnT concentrations are poorly correlated with a non-linear relationship. The purpose of this study is to determine whether patients with different ratios of hs-cTnI and hs-cTnT are phenotypically distinct. Methods: The study included a consecutive patient cohort that presented to a single academic institution between June and July 2020. Only the first admission and the first corresponding pair of troponin values obtained was analyzed. Patients with both hs-cTnI and hs-cTnT > 99 th percentile URL (≥ 28 ng/L for hs-cTnI and ≥19 ng/L for hs-cTnT) were categorized based on their hs-cTnT to hs-cTnT ratio (I/T ratio). Patient demographic, clinical characteristics, and adjudicated final diagnoses were compared among tertiles of I/T ratio. Results: Of the 809 unique patient encounters, 137 patients had both hs-cTnI and hs-cTnT > 99% URL. Patients in the lowest I/T tertile were more likely to be male, Black, and have diabetes, hypertension, CKD and CAD. The prevalence of myocardial infarction was 5% with the remaining elevated values secondary to acute or chronic non-ischemic myocardial injury. The adjudicated final diagnosis was more likely to be chronic non-ischemic myocardial injury in the lowest I/T tertile and more likely to be acute non-ischemic myocardial injury in the middle and highest tertiles. Conclusions: In this small, single center study, patients with myocardial injury and lower I/T ratio were more likely to have medical comorbidities and chronic myocardial injury as compared to the highest I/T tertile. This suggests that important phenotypic differences exist among patients with abnormal hs-cTnI and T levels. Table 1. Demographics and clinical characteristics of patient cohort with Hs-cTnI and Hs-cTnT values over 99 th percentile categorized by tertile of I/T ratio #Final adjudicated diagnoses defined as per the Fourth Universal Definition of Myocardial Infarction
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