Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay

The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts. The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small st...

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Vydáno v:	Journal of the American College of Cardiology Ročník 63; číslo 14; s. 1441
Hlavní autoři:	Gore, M Odette, Seliger, Stephen L, Defilippi, Christopher R, Nambi, Vijay, Christenson, Robert H, Hashim, Ibrahim A, Hoogeveen, Ron C, Ayers, Colby R, Sun, Wensheng, McGuire, Darren K, Ballantyne, Christie M, de Lemos, James A
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 15.04.2014
Témata:	Adult Age Factors Aged Biological Assay - methods Biomarkers - analysis Biomarkers - blood Blood Chemical Analysis Cohort Studies Cross-Sectional Studies Female Humans Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - diagnosis Reference Values Risk Assessment Sensitivity and Specificity Severity of Illness Index Sex Factors Troponin T - analysis Troponin T - blood diagnosis troponin myocardial infarction population
ISSN:	1558-3597, 1558-3597
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Abstract	The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts. The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization. Data were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race. The 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14, 21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold. Use of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay.
AbstractList	The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts. The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization. Data were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race. The 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14, 21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold. Use of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay. The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts.OBJECTIVESThe study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent cohorts.The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization.BACKGROUNDThe presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization.Data were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race.METHODSData were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race.The 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14, 21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold.RESULTSThe 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14, 21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold.Use of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay.CONCLUSIONSUse of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay.
Author	Gore, M Odette Defilippi, Christopher R Ballantyne, Christie M Christenson, Robert H Hoogeveen, Ron C Ayers, Colby R McGuire, Darren K Sun, Wensheng Seliger, Stephen L de Lemos, James A Hashim, Ibrahim A Nambi, Vijay
Author_xml	– sequence: 1 givenname: M Odette surname: Gore fullname: Gore, M Odette organization: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas – sequence: 2 givenname: Stephen L surname: Seliger fullname: Seliger, Stephen L organization: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland – sequence: 3 givenname: Christopher R surname: Defilippi fullname: Defilippi, Christopher R organization: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland – sequence: 4 givenname: Vijay surname: Nambi fullname: Nambi, Vijay organization: Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas; Michael E. DeBakey Veterans Affairs Hospital, Houston, Texas – sequence: 5 givenname: Robert H surname: Christenson fullname: Christenson, Robert H organization: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland – sequence: 6 givenname: Ibrahim A surname: Hashim fullname: Hashim, Ibrahim A organization: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas – sequence: 7 givenname: Ron C surname: Hoogeveen fullname: Hoogeveen, Ron C organization: Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas – sequence: 8 givenname: Colby R surname: Ayers fullname: Ayers, Colby R organization: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas – sequence: 9 givenname: Wensheng surname: Sun fullname: Sun, Wensheng organization: Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas – sequence: 10 givenname: Darren K surname: McGuire fullname: McGuire, Darren K organization: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas – sequence: 11 givenname: Christie M surname: Ballantyne fullname: Ballantyne, Christie M organization: Department of Medicine, Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas – sequence: 12 givenname: James A surname: de Lemos fullname: de Lemos, James A email: James.deLemos@UTSouthwestern.edu organization: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: James.deLemos@UTSouthwestern.edu
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ContentType	Journal Article
Copyright	Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Keywords	diagnosis troponin myocardial infarction population
Language	English
License	Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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PublicationTitle	Journal of the American College of Cardiology
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References	24530670 - J Am Coll Cardiol. 2014 Apr 15;63(14):1449-50. doi: 10.1016/j.jacc.2013.12.031.
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Snippet	The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T assay (hs-cTnT) in 3 large independent...
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SubjectTerms	Adult Age Factors Aged Biological Assay - methods Biomarkers - analysis Biomarkers - blood Blood Chemical Analysis Cohort Studies Cross-Sectional Studies Female Humans Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - diagnosis Reference Values Risk Assessment Sensitivity and Specificity Severity of Illness Index Sex Factors Troponin T - analysis Troponin T - blood
Title	Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay
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