Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Review

Volume 14, Number 1, February 2023, pages 22-31

Modern View on the Role of Sex-Specific Levels of High-Sensitive Cardiospecific Troponins T and I in the Diagnosis of Myocardial Infarction

**Table 1.** Main Causes of Cardiac Myocytes Damage (Physiological and Pathological) and Increased Concentration of Cardiospecific Troponins [29-34]
Nature of cardiac myocytes damage	Nosologies/reasons
Myocardial damage caused by ischemia	Acute coronary syndrome/myocardial infarction
Cardiac myocytes damage not caused by ischemia in cardiac pathologies	1) Myocarditis, endocarditis, pericarditis; 2) The use of cardiotoxic drugs, for example, anthracyclines; 3) Radiofrequency or cryoablation therapy; 4) Cardiomyopathy and heart failure; 5) Pacing or defibrillation; 6) Infiltrative pathologies of the heart, for example, amyloidosis; 7) Takotsubo syndrome
Cardiac myocytes damage not caused by ischemia in extracardiac pathologies	1) Sepsis 2) Chronic renal failure; 3) Chronic obstructive pulmonary disease; 4) Pulmonary embolism; 5) Neurogenic diseases (stroke, subarachnoid hemorrhages); 6) Arterial hypertension
Physiological conditions	1) Physical activity; 2) Stressful situations
Without cardiac myocytes damage (false positive factors)	1) Heterophilic antibodies; 2) Alkaline phosphatase; 3) Hemolysis of the sample; 4) Rheumatoid factor; 5) Fibrin clots in the sample; 6) Cross-reaction of diagnostic antibodies with skeletal troponins

Table 1. Main Causes of Cardiac Myocytes Damage (Physiological and Pathological) and Increased Concentration of Cardiospecific Troponins [29-34]

Nature of cardiac myocytes damage

Nosologies/reasons

Myocardial damage caused by ischemia

Acute coronary syndrome/myocardial infarction

Cardiac myocytes damage not caused by ischemia in cardiac pathologies

1) Myocarditis, endocarditis, pericarditis; 2) The use of cardiotoxic drugs, for example, anthracyclines; 3) Radiofrequency or cryoablation therapy; 4) Cardiomyopathy and heart failure; 5) Pacing or defibrillation; 6) Infiltrative pathologies of the heart, for example, amyloidosis; 7) Takotsubo syndrome

Cardiac myocytes damage not caused by ischemia in extracardiac pathologies

1) Sepsis 2) Chronic renal failure; 3) Chronic obstructive pulmonary disease; 4) Pulmonary embolism; 5) Neurogenic diseases (stroke, subarachnoid hemorrhages); 6) Arterial hypertension

Physiological conditions

1) Physical activity; 2) Stressful situations

Without cardiac myocytes damage (false positive factors)

1) Heterophilic antibodies; 2) Alkaline phosphatase; 3) Hemolysis of the sample; 4) Rheumatoid factor; 5) Fibrin clots in the sample; 6) Cross-reaction of diagnostic antibodies with skeletal troponins

**Table 2.** Main Analytical Characteristics, Including Sex Specifications, of Modern High-Sensitive Cardiospecific Troponin Immunotests [35]
Manufacturer of the immunotest	LoD, ng/L	CV, %	Characteristics of the examined healthy population, number, sex, age	99th percentile, ng/L	Type of test sample	Percentage of measurable values (above LoD, but less than 99th percentile), %
A more complete version of the table for other test systems can be found on the IFCC website [35]. LoD: limit of detection (minimum detectable concentration); CV: coefficient of variation; M: men. W: women; EDTA: ethylenediaminetetraacetate.
Abbott/Alinity i systems/Alinity i STAT High Sensitive Troponin-I; commercial-OUS	1.6	4.0	For 21 - 75 years old: n = 1,530; M = 764; W = 766	Total = 26.2; M = 34.2; W = 15.6	Plasma with anticoagulants (lithium heparin or K2EDTA, or K3EDTA) or serum	Total = 85; M = 92; W = 78
Beckman Coulter/Access 2, DxI/Access hsTnI; commercial-OUS	1.0 - 2.3	3.7	For 21 - 99 years old: n = 1,089; M = 595; W = 494	Total = 17.5; M = 19.8; W = 11.6	Plasma containing lithium heparin	Total > 50, no data on sex characteristics
BioMerieux VIDAS High Sensitive Troponin I; commercial	3.2	7.0	For 41 - 80 years old: n = 815; M = 447; W = 368	Total = 19.0; M = 25.0; W = 11.0	Serum or plasma with anticoagulant (lithium heparin)	No data provided
ET Healthcare Pylon hsTnI assay; China FDA approved	1.2 - 1.4	10.0	For 15 - 91 years old: n = 863; M = 425; W = 438	Total = 27.0; M = 27.0; W = 21.0	Plasma with anticoagulant (EDTA) or serum or whole blood	Total = 91; M = 94; W = 89
Fujirebio Lumipulse G G1200 and G600II hsTnI	2.1	≤ 4.6	For 18 - 90 years old: n = 1,018; M = 590; W = 428	Total = 29.6; M = 32.8; W = 27.8	Plasma with anticoagulant (lithium heparin)	Total = 65, no data on sex characteristics
LSI Medience (formerly Mitsubishi) PATHFAST cTnI; commercial	1.0	< 6.0	For 18 - 86 years old: n = 474; M = 238; W = 236	Total = 15.48; M = 16.91; W = 11.46	Plasma with anticoagulant (sodium heparin or lithium heparin or EDTA)	Total = 76.3, no data on sex characteristics
Ortho/VITROS/hsTroponin I; commercial	0.39 - 0.86	< 10.0	For 22 - 91 years: n = 952; M = 466; W = 486	Total = 11.0; M = 12.0; W = 9.0	Blood serum	Total > 50, no data on sex characteristics
Quidel/Alere Triage True hs-cTnI	0.7 - 1.6	5.0 - 5.9	n = 789; M = 398; W = 391	Total = 20.5; M = 25.7; W = 14.4	Blood plasma with anticoagulant EDTA	Total ≥ 50, no data on sex characteristics
Roche/cobas e601, e602, E170/cTnT-hs 18-min; commercial	2.05	< 10	For 20 - 71 years old: n = 533; W = 49.7%	Total = 14.0; M = 16.0; W = 9	Serum or plasma with anticoagulants (EDTA, heparin)	Total > 71.5, no data on sex characteristics
Siemens ATELLICA High-Sensitivity TnI (TnIH), US & OUS; commercial	1.6	< 4.0	For 22 - 91 years old: n = 2,007; M = 1,000; W = 1,007	Total = 45.2; M = 53.5; W = 34.1	Serum or plasma with anticoagulant (heparin)	Total = 71; M = 84; W = 58

Table 2. Main Analytical Characteristics, Including Sex Specifications, of Modern High-Sensitive Cardiospecific Troponin Immunotests [35]

Manufacturer of the immunotest

LoD, ng/L

CV, %

Characteristics of the examined healthy population, number, sex, age

99th percentile, ng/L

Type of test sample

Percentage of measurable values (above LoD, but less than 99th percentile), %

A more complete version of the table for other test systems can be found on the IFCC website [35]. LoD: limit of detection (minimum detectable concentration); CV: coefficient of variation; M: men. W: women; EDTA: ethylenediaminetetraacetate.

Abbott/Alinity i systems/Alinity i STAT High Sensitive Troponin-I; commercial-OUS

1.6

4.0

For 21 - 75 years old: n = 1,530; M = 764; W = 766

Total = 26.2; M = 34.2; W = 15.6

Plasma with anticoagulants (lithium heparin or K2EDTA, or K3EDTA) or serum

Total = 85; M = 92; W = 78

Beckman Coulter/Access 2, DxI/Access hsTnI; commercial-OUS

1.0 - 2.3

3.7

For 21 - 99 years old: n = 1,089; M = 595; W = 494

Total = 17.5; M = 19.8; W = 11.6

Plasma containing lithium heparin

Total > 50, no data on sex characteristics

BioMerieux VIDAS High Sensitive Troponin I; commercial

3.2

7.0

For 41 - 80 years old: n = 815; M = 447; W = 368

Total = 19.0; M = 25.0; W = 11.0

Serum or plasma with anticoagulant (lithium heparin)

No data provided

ET Healthcare Pylon hsTnI assay; China FDA approved

1.2 - 1.4

10.0

For 15 - 91 years old: n = 863; M = 425; W = 438

Total = 27.0; M = 27.0; W = 21.0

Plasma with anticoagulant (EDTA) or serum or whole blood

Total = 91; M = 94; W = 89

Fujirebio Lumipulse G G1200 and G600II hsTnI

2.1

≤ 4.6

For 18 - 90 years old: n = 1,018; M = 590; W = 428

Total = 29.6; M = 32.8; W = 27.8

Plasma with anticoagulant (lithium heparin)

Total = 65, no data on sex characteristics

LSI Medience (formerly Mitsubishi) PATHFAST cTnI; commercial

1.0

< 6.0

For 18 - 86 years old: n = 474; M = 238; W = 236

Total = 15.48; M = 16.91; W = 11.46

Plasma with anticoagulant (sodium heparin or lithium heparin or EDTA)

Total = 76.3, no data on sex characteristics

Ortho/VITROS/hsTroponin I; commercial

0.39 - 0.86

< 10.0

For 22 - 91 years: n = 952; M = 466; W = 486

Total = 11.0; M = 12.0; W = 9.0

Blood serum

Total > 50, no data on sex characteristics

Quidel/Alere Triage True hs-cTnI

0.7 - 1.6

5.0 - 5.9

n = 789; M = 398; W = 391

Total = 20.5; M = 25.7; W = 14.4

Blood plasma with anticoagulant EDTA

Total ≥ 50, no data on sex characteristics

Roche/cobas e601, e602, E170/cTnT-hs 18-min; commercial

2.05

< 10

For 20 - 71 years old: n = 533; W = 49.7%

Total = 14.0; M = 16.0; W = 9

Serum or plasma with anticoagulants (EDTA, heparin)

Total > 71.5, no data on sex characteristics

Siemens ATELLICA High-Sensitivity TnI (TnIH), US & OUS; commercial

1.6

< 4.0

For 22 - 91 years old: n = 2,007; M = 1,000; W = 1,007

Total = 45.2; M = 53.5; W = 34.1

Serum or plasma with anticoagulant (heparin)

Total = 71; M = 84; W = 58