Troponin I and T in relation to cardiac injury detected with electrocardiography in a population-based cohort - The Maastricht Study

Abstract

Interest in high-sensitivity cardiac troponin I(hs-cTnI) and T(hs-cTnT) has expanded from acute cardiac care to cardiovascular disease(CVD) risk stratification. Whether hs-cTnI and hs-cTnT are interchangeable in the ambulant setting is largely unexplored. Cardiac injury is a mechanism that may underlie the associations between troponin levels and mortality in the general population. In the population-based Maastricht Study, we assessed the correlation and concordance between hs-cTnI and hs-cTnT. Multiple regression analyses were conducted to assess the association of hs-cTnI and hs-cTnT with electrocardiographic (ECG) changes indicative of cardiac abnormalities. In 3016 eligible individuals(mean age,60 ± 8years;50.6%,men) we found a modest correlation between hs-cTnI and hs-cTnT(r = 0.585). After multiple adjustment, the association with ECG changes indicative of cardiac abnormalities was similar for both hs-cTn assays(OR,hs-cTnI:1.72,95%CI:1.40-2.10;OR,hs-cTnT:1.60,95%CI:1.22-2.11). The concordance of dichotomized hs-cTnI and hs-cTnT was κ = 0.397(≥sex-specific 75^th percentile). Isolated high levels of hs-cTnI were associated with ECG changes indicative of cardiac abnormalities(OR:1.93,95%CI:1.01-3.68), whereas isolated high levels of hs-cTnT were not(OR:1.07,95%CI:0.49-2.31). In conclusion, there is a moderate correlation and limited concordance between hs-cTnI and hs-cTnT under non-acute conditions. These data suggest that associations of hs-cTnI and hs-cTnT with cardiac injury detected by ECG are driven by different mechanisms. This information may benefit future development of CVD risk stratification algorithms.

Figure 1

Correlation between natural log transformed hs-cTnI and natural log transformed hs-cTnT (β = 0.465, 95% CI 0.442–0.488, p < 0.001, R² = 0.343). Abbreviations: hs-cTnI, high-sensitivity cardiac troponin I; hs-cTnT, high-sensitivity cardiac troponin T; ln, natural log transformed.

Figure 2

Prevalence of ECG changes indicative of cardiac abnormalities per hs-cTnI quartile, stratified by sex (women; panel A: men; panel B). Abbreviations: ECG, electrocardiographic; hs-cTnI, high-sensitivity cardiac troponin I.

Figure 3

Associations between combined hs-cTn categories and ECG changes indicative of cardiac abnormalities. Definitions of “low” and “high” hs-cTn categories were based on the sex-specific 75^th percentiles of hs-cTnI and hs-cTnT (hs-cTnI, women: 2.20 ng/L; hs-cTnI, men: 3.70 ng/L; hs-cTnT, women: 5.55 ng/L; hs-cTnT, men: 9.36 ng/L). Category “low” included participants with hs-cTn levels <the sex-specific 75^th percentile and category “high” included participants ≥the sex-specific 75^th percentile. Model was adjusted for sex, age, glucose metabolism status, eGFR, smoking behavior, total-to-HDL cholesterol ratio, triglyceride levels, lipid-modifying medication, office systolic blood pressure, antihypertensive medication, waist-to-hip ratio, alcohol consumption and educational level. Abbreviations: ECG, electrocardiographic; eGFR, estimated Glomerular Filtration Rate; HDL, high-density lipoprotein; hs-cTnI, high-sensitivity cardiac troponin I; hs-cTnT, high-sensitivity cardiac troponin T.

Figure 4

ECG changes indicative of cardiac abnormalities categorized according to Whitehall criteria into “probable”, “possible” and “unlikely”. Abbreviations: ECG, electrocardiography; MC, Minnesota Coding.