Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay.
Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay.
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DOI：
10.1016/j.jacc.2013.12.032
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发表时间：
2014-04-15
影响因子：
24
通讯作者：
de Lemos, James A.
中科院分区：
文献类型：
--
作者：
Gore, M. Odette;Seliger, Stephen L.;deFilippi, Christopher R.;Nambi, Vijay;Christenson, Robert H.;Hashim, Ibrahim A.;Hoogeveen, Ron C.;Ayers, Colby R.;Sun, Wensheng;McGuire, Darren K.;Ballantyne, Christie M.;de Lemos, James A.
在3个大型独立队列中确定高灵敏度心肌肌钙蛋白T测定（hs-cTnT）的第99百分位数参考上限。目前推荐的使用hs-cTnT检测诊断心肌梗死的临界点为14 ng/L，该临界点来自于对假定健康个体的小型研究，表型特征相对较少。数据来自三项充分表征的基于人群的研究：达拉斯心脏研究（DHS）、社区动脉粥样硬化风险研究（ARIC）和心血管健康研究（CHS）。在每个队列中，定义参考亚队列，排除近期住院、明显心血管疾病和肾脏疾病的个体（亚队列1），并进一步排除亚临床结构性心脏病患者（亚队列2）。数据按年龄、性别和种族分层分析。DHS、ARIC和CHS中hs-cTnT测定的第99百分位数值分别为18、22和36 ng/L（子队列1）以及14、21和28 ng/L（子队列2）。这些第99百分位值的差异表明了队列间的年龄差异。性别/年龄分层内的分析在队列之间产生了相似的结果。在每个队列中，第99百分位数值随年龄增加而增加，男性更高。在我们的研究中，超过10%的年龄在65-74岁的无心血管疾病的男性cTnT值高于当前的心肌梗死阈值。hs-cTnT检测使用统一的14 ng/L临界值可能导致心肌梗死的过度诊断，尤其是在男性和老年人中。需要对该检测的新年龄和性别特异性临界值进行临床验证。
To determine the 99th percentile upper reference limit for the highly sensitive cardiac troponin T assay (hs-cTnT) in three large independent cohorts. The presently recommended 14 ng/L cutpoint 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. Data were included from three 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. The 99th percentile values for the hs-cTnT assay in DHS, ARIC and CHS were 18, 22 and 36 ng/L respectively (subcohort 1) and 14, 21 and 28 ng/L respectively (subcohort 2). 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 aged 65–74 with no cardiovascular disease in our study had cTnT values above the current myocardial infarction threshold. 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.
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影响因子：
3.5
作者：
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通讯作者：
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