High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors
Authors' conclusion
In ambulatory patients with cancer receiving ICI therapy, over one-third had elevated hs-cTnT with normal hs-cTnI: a stable, nonspecific pattern present before ICI exposure and consistent with noncardiac sources rather than acute cardiac injury. hs-cTnI is the more cardiac-specific assay; paired baseline measurement of both troponins may help contextualize later elevations when myocarditis is suspected.
Study context
- Population
- Ambulatory patients with cancer starting immune checkpoint inhibitor (ICI) therapy, excluding adjudicated ICI-associated myocarditis or myositispatients with paired baseline measurements, 329 with paired data at baseline and 1 month
- Participants
- 433 patients
- Exposure
- Paired hs-cTnT (Roche Elecsys) and high-sensitivity cardiac troponin I (hs-cTnI) (Siemens Atellica) measurements in the same banked samples at baseline and 1 month
- Outcome
- Elevated troponin at baseline
- Follow-up
- Baseline
Main finding
As reported in the abstract
- Discordant (elevated hs-cTnT, normal hs-cTnI)
- 158 (36.5%)
- Normal levels of both
- 267 (61.7%)
- κ
- 0.036
Observational data: associations, not effects.
Further findings
All-cause mortality · median follow-up of 30.1 months (reverse Kaplan-Meier)
| Comparison | Adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Elevated hs-cTnT | 1.35 (1.00–1.81) | P = 0.048 | |
| 0.512Adjusted hazard ratio (log scale) |
- All-cause mortality — cardiac deaths
- 8 of 231 deaths (3.5%)
Discordance prevalence, baseline vs 1 month (329 patients with paired data)
- Discordance prevalence baseline vs 1 month
- 38.3% vs 38.0%
- McNemar P > 0.99
Independent correlates of discordance
- Older age, male sex, and chronic kidney disease
- all P < 0.05
Original publication
Summarised from the published abstract; every number is checked against it