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Canadian Journal of Cardiology

Variability in High-Sensitivity Cardiac Troponin T Testing in Stable Patients With and Without Coronary Artery Disease

Published:August 22, 2019DOI:https://doi.org/10.1016/j.cjca.2019.08.022

      Abstract

      Background

      High-sensitivity cardiac troponin T (hs-cTnT) is used to diagnosis acute myocardial infarction, often based on values exceeding the 99th percentile threshold (14 ng/L) of normal populations. The short- and long-term variability of hs-cTnT in stable patients with or without coronary artery disease (CAD) is unknown.

      Methods

      Prospective cohort study of 75 stable patients with CAD and 3 differing clinical profiles (stable angina [SA]; remote myocardial infarction [MI]; repetitive acute coronary syndrome [ACS]) and 25 controls without angiographic CAD, each with 15 hs-cTnT measurements over 1 year.

      Results

      Individual results (1491 measurements) did not vary over within-day, daily, weekly, monthly, seasonal, or yearly time windows. The overall median was 2.8 ng/L (interquartile range [IQR] 5.2 ng/L) with the highest median (6.3 ng/L) and variability (IQR 6. 9 ng/L) in the repetitive ACS group. Diabetes, impaired renal function, and raised C-reactive protein were independent predictors of higher hs-cTnT values (average increase by 8.5 ng/L [95% CI, 5.0-11.9], 5.0 ng/L [95% CI, 2.0-8.1] and 4.0 ng/L (95% CI, 1.0-7.0), respectively). The 99th percentile value of all hs-cTnT measurements in the combined stable patients with CAD was 39 ng/L compared with 14 ng/L in the non-CAD patients.

      Conclusions

      Individual hs-cTnT readings in both patients with and without CAD were stable over hours, days, weeks, and months. Diabetes, poor renal function, and elevated C-reactive protein were independent predictors of higher median and IQR hs-cTnT values, often exceeding conventional thresholds. These findings highlight the need for caution and clinical contextualization in the interpretation of hs-cTnT results.

      Résumé

      Contexte

      La troponine T cardiaque hautement sensible (TnTc-hs) est utilisée pour le diagnostic de l'infarctus aigu du myocarde, lorsque sa concentration est supérieure à la valeur seuil pour le 99e percentile (14 ng/l) dans la population normale. La variabilité à court et à long terme de la TnTc-hs chez les sujets dont l'état est stable, qu'ils soient ou non atteints de coronaropathie, n'est pas connue.

      Méthodologie

      Étude de cohorte prospective regroupant 75 patients atteints de coronaropathie dont l'état était stable, présentant 3 profils cliniques distincts (angine stable; infarctus du myocarde passé; événements coronariens aigus répétitifs) et 25 sujets témoins sans coronaropathie à l'angiographie, chacun ayant subi 15 mesures de la TnTc-hs sur une période de 1 an.

      Résultats

      Les résultats individuels (1 491 mesures) n’ont pas varié selon le temps de la journée, les jours de la semaine, les semaines du mois, d’un mois à l’autre, d’une saison à l’autre ou à une intervalle d’une année. La concentration médiane dans l'ensemble était de 2,8 ng/l (intervalle interquartile [IIQ] de 5,2 ng/l), la concentration médiane la plus élevée (6,3 ng/l) et la variabilité la plus grande (IIQ de 6,9 ng/l) étant observées dans le groupe avec événements coronariens aigus répétitifs. Le diabète, l'insuffisance rénale et un taux élevé de protéine C réactive constituaient des facteurs prédictifs indépendants d'une concentration plus élevée de TnTc-hs (augmentation moyenne de 8,5 ng/l [intervalle de confiance (IC) à 95 %: de 5,0 à 11,9], 5,0 ng/l [IC à 95 % : de 2,0 à 8,1] et 4,0 ng/l [IC à 95 % : de 1,0 à 7,0], respectivement). La valeur correspondant au 99e percentile pour toutes les mesures de la TnTc-hs chez l'ensemble des patients atteints de coronaropathie dont l'état était stable était de 39 ng/l, comparativement à 14 ng/l chez les sujets non atteints de coronaropathie.

      Conclusions

      Les mesures individuelles de la TnTc-hs chez les sujets atteints ou non de coronaropathie étaient stables d'une heure, d'une journée, d'une semaine et d'un mois à l'autre. Le diabète, une mauvaise fonction rénale et un taux élevé de protéine C réactive constituaient des facteurs prédictifs indépendants d'une concentration médiane et d'un IIQ plus élevés pour la TnTc-hs, excédant souvent les valeurs seuils habituelles. Ces résultats démontrent la nécessité de faire preuve de prudence et de prendre en considération le contexte clinique au moment d'interpréter les résultats pour la TnTc-hs.
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