Proposition of reference tables for hs-cTnI to define “normal” considering relevant determinants in the general population
J Lehmacher, A Haack, N A Soerensen, A Petersmann, S Blankenberg, J T Neumann, R TwerenboldAbstract
Background
High-sensitivity cardiac troponin (hs-cTn) is a well-established diagnostic and prognostic biomarker in different settings. Despite high specificity for cardiomyocyte damage, various factors like sex, age, renal function and prevalent cardiovascular disease influence hs-cTn concentrations, making interpretation of results complicated for physicians. Currently, data on reference values of hs-cTnI in the general population and clinically relevant patient subsets is scarse.
Purpose
We aimed to determine and establish practical reference values of a 5th generation hs-cTnI considering key determinants in the general population
Methods
We analyzed cross-sectional data from participants of the population-based, aged between 45 to 79 years were enrolled after being identified via registration office, receiving extensive physical examination and assessment of medical history including measurement of 5th generation hs-cTnI. Uni- and multivariable linear regression analyses were performed to assess the potential association of log-transfomed hs-cTnI concentrations with sex, age, estimated glomerular filtration rate (eGFR) and prevalent cardiovascular disease (CVD). Additionally, reference tables for median hs-cTnI concentrations were generated to provide reference values for different subsets of individuals in the general population.
Results
In 15,351 patients (median age 60 years, 48.9% female), hs-cTnI concentrations were significantly and independently associated with sex, age, eGFR and CVD in uni- and multivariable analyses (Table 1). Median hs-cTnI concentrations in females ranged from 1.3ng/l in patients <60 years, eGFR >90ml/min/m² and without CVD to 6.7ng/l in individuals ≥70 years, eGFR <45ml/min/m² and known CVD, resembling a variation by factor 5. In male patients, median hs-cTnI concentrations ranged between 2.2ng/l and 13.4ng/l in the respective population subsets, thus varying by factor 6 (Table 2).
Conclusion
Sex, age, CVD and eGFR are independent and significant determinants of hs-cTnI concentrations in the general population, with substantial influence on median concentrations across various subgroups. Reference tables, taking these factors into account may ease interpretation of hs-cTnI concentrations by contrasting measured with expectable hs-cTnI concentrations, potentially improving clinical decision making especially in heterogenous real-world diseased populations.