By Vishnu Samara, PhD, DABCC
Current high-sensitivity cardiac troponin (hs-cTn) assays, which are used to rapidly assess the risk of an ongoing myocardial infarction (MI), recognize sex-based differences in cardiac troponin concentrations. Thursday’s session, titled “Do sex differences in cardiac troponin cut-offs matter?,” will explore various mechanisms that underpin these differences and the role of cTn in determining patients’ prognosis.
Allan Jaffe, MD, a cardiovascular and laboratory medicine consultant from Mayo Clinic, will discuss the use of sex-specific cutoffs for risk prediction of non-ST elevation MI in the emergency department. He will discuss how hs-cTn assays allow for rapid decision-making, noting that sex-specific cutoffs can improve the identification of at-risk women, particularly those who present atypically. While better diagnostics are not the sole solution to overcoming sex disparities in acute coronary syndrome evaluation, they are an important step forward, Jaffe says.
He will describe benefits and controversies surrounding sex-specific cutoffs for both troponin T and troponin I assays, justifying their use based on fundamental pathophysiological differences between men and women, such as varying patterns of plaque formation and endothelial dysfunction. In addition, Jaffe will cover the upcoming fifth iteration of a medical definition for MI, which will replace the current universal definition, and the role of point-of-care devices for measuring hs-cTn, which may require additional considerations for calculation and implementation.
Dorien Kimenai, PhD, a cardiac epidemiologist from the University of Edinburgh, will present on the clinical consequences of changing from using the uniform hs-cTn threshold to sex-specific cut-offs. She will share information on the use of cardiac troponins for diagnosing MI and preventing cardiac issues, along with data on laboratories that use a uniform threshold. She will discuss the data from the “Cardiac Troponin — Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women” (CODE-MI) study and the “Danish Study of Sex- and Population-Specific 99th percentile upper reference limits of Troponin” (DANSPOT). Kimenai will also emphasize the need for additional research into cardiac troponin concentrations in transgender individuals.
Finally, Torbjorn Omland, MD, PhD, professor of medicine at the University of Oslo, will discuss the measurement of cardiac troponins I and T with high-sensitivity assays as markers of subclinical cardiac injury. These tests provide strong, long-term prognostic information across a broad spectrum of patients, from healthy individuals to patients with established cardiovascular disease. In addition, the prognostic value seems to be of greater importance in women than in men.
As cardiac troponins are increasingly recognized as strong prognostic markers, it is important for laboratory medicine professionals to understand important differences between men and women, both in terms of circulating concentrations of cardiac troponins and in their prognostic value. The main knowledge gaps and challenges relate to the following questions: What will be the optimal decision limits in men and women? What do changes in concentrations mean? And what interventions are appropriate for those with concentrations above the decision limits?
This session will be very useful for all laboratory personnel working with cardiac markers, particularly those currently working with cTn in clinical contexts.