Abstract
(1) Background: Highly sensitive cardiac troponin T (hs-cTnT) plays an essential role in the diagnosis of myocardial injury. The upper reference limit of the respective assay is generally applied, irrespective of age, renal function, or sex. We aimed to identify age-adjusted and sex-adjusted upper reference limits in relation to renal function in a large population-based cohort without cardiac diseases. (2) Methods: We included 5428 subjects of the population-based LIFE-Adult cohort, free of diagnosed cardiac diseases. Sex-adjusted and age-adjusted 99th percentiles for hs-cTnT in subjects with preserved renal function were obtained. (3) Results: The hs-cTnT values were higher in men of all age groups. In both sexes, an increasing age positively correlated with higher hs-cTnT values. Hs-cTnT weakly correlated with serum creatinine. The three-dimensional analysis of age, creatinine, and hs-cTnT showed no relevant additional effect of creatinine on hs-cTnT. In men aged above 60 and women above 70, the calculated 99th percentiles clearly exceeded the commonly applied thresholds. (4) Conclusion: Age and sex have a major impact on the serum concentration of hs-cTnT, while renal function does not. We propose to consider age-adjusted and sex-adjusted reference values.
Highlights
Accepted: 13 November 2021Highly sensitive cardiac troponin T has evolved into an essential diagnostic tool to detect myocardial injury—especially in patients presenting with acute chest pain.By definition, troponin T values above the 99th percentile compared to a healthy reference population are declared elevated [1,2,3]
This 99th percentile is generally used as an upper reference limit concentration for delineation in rule-in and rule-out algorithms according to the currently used guidelines for the management of patients presenting with acute coronary syndromes without persistent ST-segment elevation [1,2]
A total of 5636 participants were included in the analysis of Highly sensitive cardiac troponin T (hs-cTnT) values in relation to age, sex, and kidney function
Summary
Accepted: 13 November 2021Highly sensitive cardiac troponin T (hs-cTnT) has evolved into an essential diagnostic tool to detect myocardial injury—especially in patients presenting with acute chest pain.By definition, troponin T values above the 99th percentile compared to a healthy reference population are declared elevated [1,2,3]. Sensitive cardiac troponin T (hs-cTnT) has evolved into an essential diagnostic tool to detect myocardial injury—especially in patients presenting with acute chest pain. For the widely used Elecsys® fifth generation hs-cTnT assay developed by Roche Diagnostics, the upper reference limit of 14 ng/L was derived and confirmed [4,5]. This 99th percentile is generally used as an upper reference limit concentration for delineation in rule-in and rule-out algorithms according to the currently used guidelines for the management of patients presenting with acute coronary syndromes without persistent ST-segment elevation [1,2]. The currently used upper reference limits do not consider these factors, relevant effects on hs-cTnT have been reported in multiple studies
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