Author + information
- Received September 22, 2013
- Revision received November 30, 2013
- Accepted December 23, 2013
- Published online April 15, 2014.
- M. Odette Gore, MD, MSCS∗,
- Stephen L. Seliger, MD, MS†,
- Christopher R. deFilippi, MD†,
- Vijay Nambi, MD, PhD‡,§,
- Robert H. Christenson, PhD‖,
- Ibrahim A. Hashim, PhD¶,
- Ron C. Hoogeveen, PhD‡,
- Colby R. Ayers, MS∗,#,
- Wensheng Sun, MS‡,
- Darren K. McGuire, MD, MHSc∗∗∗,
- Christie M. Ballantyne, MD‡ and
- James A. de Lemos, MD∗∗∗∗ ()
- ∗Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- †Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- ‡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
- ‖Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
- ¶Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
- #Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- ∗∗Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Reprint requests and correspondence:
Dr. James A. de Lemos, Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8830.
Objectives 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.
Background 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.
Methods 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.
Results 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.
Conclusions 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 Dallas Heart Study was supported by the Donald W. Reynolds Foundation (Las Vegas, Nevada) and by grant UL1-TR000451 from the National Center for Advancing Translational Sciences, National Institutes of Health. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts HHSN268201100005C through HHSN268201100012C. The Cardiovascular Health Study was supported by NHLBI grant HL080295 and by NHLBI contracts N01-HC-85239, N01-HC-85079 through N01-HC-85086; N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, and N01-HC-45133, with additional support from the National Institute of Aging (AG-023629, AG-15928, AG-20098, and AG-027058). Dr. Gore is supported by training grant T32-HL007360 from the NHLBI. Drs. Seliger, deFilippi, Nambi, Christenson, Ballantyne, Hoogeveen, and de Lemos have received grant funding from Roche Diagnostics. Drs. Seliger and de Lemos have received consulting fees from Roche Diagnostics. Dr. deFilippi has received honoraria and consulting fees from Roche Diagnostics. Dr. Nambi has conducted research in collaboration with GE and Tomtec. Drs. Ballantyne, Nambi, and Hoogeveen have a provisional patent filed with Roche Diagnostics. Dr. de Lemos has received grant support and consulting income from Abbott Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 22, 2013.
- Revision received November 30, 2013.
- Accepted December 23, 2013.
- American College of Cardiology Foundation