Age- and Sex-Dependent Upper Reference Limits for the High-Sensitivity Cardiac Troponin T Assay

被引：297

作者：

Gore, M. Odette ^{[1
]}

Seliger, Stephen L. ^{[2
]}

deFilippi, Christopher R. ^{[2
]}

Nambi, Vijay ^{[3
,4
]}

Christenson, Robert H. ^{[5
]}

Hashim, Ibrahim A. ^{[6
]}

Hoogeveen, Ron C. ^{[3
]}

Ayers, Colby R. ^{[1
,7
]}

Sun, Wensheng ^{[3
]}

McGuire, Darren K. ^{[1
,8
]}

Ballantyne, Christie M. ^{[3
]}

de Lemos, James A. ^{[1
,8
]}

机构：

[1] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Dallas, TX 75390 USA

[2] Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA

[3] Baylor Coll Med, Dept Med, Ctr Cardiovasc Dis Prevent, Methodist DeBakey Heart & Vasc Ctr, Houston, TX 77030 USA

[4] Michael E DeBakey Vet Affairs Hosp, Houston, TX USA

[5] Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA

[6] Univ Texas SW Med Ctr Dallas, Dept Pathol, Dallas, TX 75390 USA

[7] Univ Texas SW Med Ctr Dallas, Dept Clin Sci, Dallas, TX 75390 USA

[8] Univ Texas SW Med Ctr Dallas, Donald W Reynolds Cardiovasc Clin Res Ctr, Dallas, TX 75390 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 14期

基金：

美国国家卫生研究院;

关键词：

diagnosis; myocardial infarction; population; troponin; 99TH PERCENTILE; EARLY-DIAGNOSIS; MYOCARDIAL-INFARCTION; REFERENCE POPULATION; HEART-FAILURE; MORTALITY; ASSOCIATION; RISK;

D O I：

10.1016/j.jacc.2013.12.032

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (c) 2014 by the American College of Cardiology Foundation

引用

页码：1441 / 1448

页数：8

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