Key result
Sex-specific 99th percentile thresholds for high-sensitive cardiac troponins are needed to prevent underdiagnosis of acute coronary syndrome in women and overdiagnosis in men.
Why the study?
Sex-specific serum levels of cardiospecific troponins T and I represent an important factor that may affect early diagnostic algorithms for myocardial infarction.
Implementing sex-specific thresholds for high-sensitive troponin assays is crucial to avoid overdiagnosing myocardial infarction in men and underdiagnosing it in women.
May support sex-specific hs-cTn thresholds to reduce ACS misdiagnosis; leaves open need for prospective validation before practice change.
It is well known that the molecules of cardiospecific troponins T and I are localized in the troponin-tropomyosin complex of the cytoplasm of cardiac myocytes and, due to the specific localization, these cardiospecific troponins are widely used as diagnostic biomarkers of myocardial infarction. Cardiospecific troponins are released from the cytoplasm of cardiac myocytes as a result of irreversible cell damage (for example, ischemic necrosis of cardiomyocytes in myocardial infarction or apoptosis of cardiac myocytes in cardiomyopathies and heart failure) or reversible damage (for example, intense physical exertion, hypertension, the influence of stress factors, etc.). Current immunochemical methods for determining cardiospecific troponins T and I have extremely high sensitivity to subclinical (minor) damage to myocardial cells and, thanks to modern high-sensitive methods, it is possible to detect damage to cardiac myocytes in the early (subclinical) stages of a number of cardiovascular pathologies, including myocardial infarction. So, recently, leading cardiological communities (the European Society of Cardiology, the American Heart Association, the American College of Cardiology, etc.) have approved algorithms for early diagnosis of myocardial infarction based on the assessment of serum levels of cardiospecific troponins in the first 1 - 3 h after the onset of pain syndrome. An important factor that may affect early diagnostic algorithms of myocardial infarction are sex-specific features of serum levels of cardiospecific troponins T and I. This manuscript presents a modern view on the role of sex-specific serum levels of cardiospecific troponins T and I in the diagnosis of myocardial infarction and the mechanisms of formation of sex-specific serum levels of troponins.
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Aleksey M. Chaulin (2023) conducted a review in Myocardial Infarction. Sex-specific high-sensitive cardiac troponin thresholds vs. Common (non-sex-specific) thresholds was evaluated. Sex-specific 99th percentile thresholds for high-sensitive cardiac troponins are needed to prevent underdiagnosis of acute coronary syndrome in women and overdiagnosis in men.
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