Dietl, Alexander and Zimmermann, Martina E. and Brandl, Caroline and Wallner, Stefan and Burkhardt, Ralph and Maier, Lars S. and Luchner, Andreas and Heid, Iris M. and Stark, Klaus J. (2021) Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study. BMJ OPEN, 11 (11): e052004. ISSN 2044-6055,
Full text not available from this repository. (Request a copy)Abstract
Objective European guidelines recommended a uniform upper reference limit of high-sensitivity cardiac troponin T (hsTnT) to rule out non-ST segment elevation myocardial infarction. Our study aimed to provide a hsTnT reference distribution and to assess the specificity of the 14 ng/L cut-off value in the mobile population >= 70 years of age. Design A cross-sectional analysis was performed in the German AugUR study (Altersbezogene Untersuchungen zur Gesundheit der University of Regensburg). Setting Study population was the mobile population aged 70+ years living in the city and county of Regensburg, Germany. Participants A random sample was derived from the local population registries of residence. Of the 5644 individuals invited, 1133 participated (response ratio=20.1%). All participants came to the study centre and were mentally and physically mobile to conduct the protocol (face-to-face interview, blood draw and standardised transthoracic echocardiography). None of the participants was in an acute state of myocardial infarction. Results Among the 1129 individuals with hsTnT measurements (overall median=10.0 ng/L (25th, 75th percentile)=(7.0, 15.0 ng/L)), hsTnT was higher among the older individuals and higher among men (men 70-74 years median=9.6 ng/L (7.2, 13.1 ng/L); men 90-95 years median=21.2 ng/L (14.6, 26.0 ng/L); women 70-74 years median=6.3 ng/L (4.7, 8.7 ng/L); and women 90-95 years median=18.0 ng/L (11.0, 21.0 ng/L)). In participants with impaired kidney function (eGFR(crea) <60 mL/min/1.73 m(2)), hsTnT was elevated (median=13.6 ng/L (9.4, 20.6 ng/L)). Specificity of recommended upper reference limit, 14 ng/L, is 68%. Most false positives were among men aged >79 years (specificity=34%). In a healthy subgroup (n=96, none of the following: overt heart disease, impaired renal function, blood pressure >160/100 mm Hg, left ventricular hypertrophy and diastolic/systolic dysfunction), specificity was 90%. Conclusion In the elderly population without acute myocardial infarction, hsTnT further increases with age showing different levels for men and women. The specificity of the 14 ng/L cut-off is considerably lower than 99%, even in healthy subjects.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | HEART-FAILURE; ATHEROSCLEROSIS RISK; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; ESC GUIDELINES; SEX; ECHOCARDIOGRAPHY; RECOMMENDATIONS; DETERMINANTS; DYSFUNCTION; cardiology; cardiac epidemiology; myocardial infarction; clinical chemistry; geriatric medicine |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Augenheilkunde Medicine > Lehrstuhl für Innere Medizin II Medicine > Lehrstuhl für Klinische Chemie und Laboratoriumsmedizin Medicine > Institut für Epidemiologie und Präventivmedizin > Lehrstuhl für Genetische Epidemiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 05 Jul 2022 06:47 |
| Last Modified: | 05 Jul 2022 06:47 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45589 |
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