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. 2022 May 1;106(5):1024-1030.
doi: 10.1097/TP.0000000000003876. Epub 2021 Jun 29.

High-sensitivity Cardiac Troponin Is Not Associated With Acute Cellular Rejection After Heart Transplantation

Sarah J Fitzsimons  1 , Jonathan D W Evans  2 , Doris M Rassl  3 , Kuan Ken Lee  4 , Fiona E Strachan  4 , Jayan Parameshwar  1 , Nicholas L Mills  4   5 , Stephen J Pettit  1
Affiliations

High-sensitivity Cardiac Troponin Is Not Associated With Acute Cellular Rejection After Heart Transplantation

Sarah J Fitzsimons et al. Transplantation. .

Abstract

Background: Acute cellular rejection (ACR) is common in the first year after cardiac transplantation, and regular surveillance endomyocardial biopsy (EMB) is required. An inexpensive, simple noninvasive diagnostic test would be useful. Prior studies suggest cardiac troponin (cTn) has potential as a "rule-out" test to minimize the use of EMB. Our aim was to determine whether a new high-sensitivity cardiac troponin I (hs-cTnI) assay would have utility as a "rule-out" test for ACR after heart transplantation.

Methods: Blood samples at patient follow-up visits were collected and stored over a period of 5 y. Serum cTnI concentrations were measured using the ARCHITECTSTAT hs-cTnI assay and compared with an EMB performed on the same day. Receiver-operator curve analysis based on mixed-effects logistic regression models that account for repeated measurements in individuals was performed to determine a serum troponin level below which ACR could be reliably excluded.

Results: One hundred seventy patients had 883 serum hs-cTnI results paired to a routine surveillance EMB. Fifty-one (6%) EMB showed significant ACR (grade ≥2R). Receiver-operator curve analysis approximated the null hypothesis area under the curve 0.509 (95% CI, 0.428-0.591). Sub-analysis including repeated hs-cTnI levels in a single individual, and early (<3 mo) EMB also showed no diagnostic utility of hs-cTnI measurement (area under the curve 0.512).

Conclusions: In the largest published study to date, we found no association between hs-cTnI concentration and the presence of significant ACR on surveillance EMB. Measurement of hs-cTnI may not be a useful technique for diagnosis or exclusion of ACR after heart transplantation.

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Conflict of interest statement

K.K.L. has received an honorarium unrelated to this research from Abbotts Diagnostics and N.L.M. has received honorarium and grants unrelated to this research, from Abbots Diagnostics, Roche Diagnostics, and Siemens Healthcare. The other authors declare no conflicts of interest.

References

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    1. Fitzsimons S, Evans J, Parameshwar J, et al. Utility of troponin assays for exclusion of acute cellular rejection after heart transplantation: a systematic review. J Heart Lung Transplant. 2018;37:631–638.
    1. Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24:1710–1720.

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