Anticipation of High-Sensitivity Troponins
According to a recent article in CAP TODAY, laboratories and hospitals in the U.S. continue to look forward to high-sensitivity troponin assays. Many medical professionals throughout the country weighed in with their anticipation and predictions, including Allan Jaffe, M.D., Professor of Medicine and Cardiology and Professor of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester, Minnesota.
According to Dr. Jaffe, “Getting to use high-sensitivity troponin in the U.S. is terribly important and will revolutionize the ability to detect patients who have chronic comorbidities and improve the ability to ferret out those who have acute myocardial infarction from those who do not."
Dr. Jaffe is an advocate of using sex-specific cutoffs for high-sensitivity troponin. It’s known that women who have heart disease or have had a myocardial infarction (MI) do worse than men despite the effective therapies seeming to help women just as much as they help men, he says. One reason women don’t fare as well, Dr. Jaffe adds, is they aren’t as rapidly detected and treated or in some cases they’re not treated at all.
“In almost all of the studies with high-sensitivity troponin, there are substantial differences in the normal ranges between men and women, with men having higher values than women.”
In addition, women have a higher percentage of nonobstructive coronary artery disease and therefore are less likely to have higher troponin values, Dr. Jaffe says. “So women with ischemic heart disease are enriched with that subset that can be hard to detect. In order to bring that out, you need to have large numbers of women who are having heart attacks, and most studies do not have adequate numbers to document the need for sex-specific cutoff values.” The large studies show, he adds, that the use of sex-specific cutoffs markedly improves the diagnosis of acute MI and, with treatment, lives are saved.
Though he favors sex-specific cut-offs, Dr. Jaffe is not an advocate of developing age-specific cutoffs. “Sex isn’t a comorbidity. We could argue about that—but let’s not.” He does believe, based on research he and colleagues have done, that the troponin changes that occur with age reflect comorbidities. “If you start trying to correct for every comorbidity and use different cutoff values, it would confound the field because there are so many things that increase troponin,” Dr. Jaffe says. The better way, he adds, is to rely on a changing pattern of values.
Read the full article for more information on high-sensitivity troponin assays.
By April Josselyn