Key result
Late cardiac troponin elevation in heart transplant recipients is associated with acute cellular rejection, but its stand-alone diagnostic accuracy is poor.
Why the study?
The value of elevated recipient cardiac troponin in diagnosing adverse outcomes in heart transplant recipients was uncertain.
Does elevated cardiac troponin accurately detect acute cellular rejection in cardiac transplant recipients?
Systematic Review (n=1,684)
Does elevated cardiac troponin accurately detect acute cellular rejection in cardiac transplant recipients?
Late troponin elevation is associated with acute cellular rejection in adult heart transplant recipients, but its stand-alone diagnostic accuracy is too poor for clinical reliance.
Answers are grounded in this paper and cite their sources.
Troponin elevation should not replace biopsy for rejection surveillance; leaves open whether serial monitoring adds value in multimodal protocols.
Cardiac troponin is well known as a highly specific marker of cardiomyocyte damage, and has significant diagnostic accuracy in many cardiac conditions. However, the value of elevated recipient troponin in diagnosing adverse outcomes in heart transplant recipients is uncertain. We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from inception until December 2020. We generated summary sensitivity, specificity, and Bayesian areas under the curve (BAUC) using bivariate Bayesian modelling, and standardised mean differences (SMDs) to quantify the diagnostic relationship of recipient troponin and adverse outcomes following cardiac transplant. We included 27 studies with 1,684 cardiac transplant recipients. Patients with acute rejection had a statistically significant late elevation in standardised troponin measurements taken at least 1 month postoperatively (SMD 0.98, 95% CI 0.33–1.64). However, pooled diagnostic accuracy was poor (sensitivity 0.414, 95% CrI 0.174–0.696; specificity 0.785, 95% CrI 0.567–0.912; BAUC 0.607, 95% CrI 0.469–0.723). In summary, late troponin elevation in heart transplant recipients is associated with acute cellular rejection in adults, but its stand-alone diagnostic accuracy is poor. Further research is needed to assess its performance in predictive modelling of adverse outcomes following cardiac transplant. Systematic Review Registration: identifier CRD42021227861
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Liu et al. (2022) conducted a systematic review in Acute cellular rejection after cardiac transplantation (n=1,684). Elevated recipient cardiac troponin vs. Non-elevated troponin / non-rejection was evaluated on Standardised mean difference of troponin measurements between acute cellular rejection and non-rejection groups (at least 1 month postoperatively) (SMD 0.98, 95% CI 0.33-1.64). Late cardiac troponin elevation in heart transplant recipients is associated with acute cellular rejection, but its stand-alone diagnostic accuracy is poor.
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