Heart, Lung and Circulation

Comparison of Perioperative High-Sensitive Troponin T and Troponin I Assays in Cardiac Surgery

Published:September 09, 2021DOI:


      Troponin measurements are among the standard parameters for monitoring perioperative myocardial ischaemia after cardiosurgical procedures. As high-sensitive assays continue to replace older analytic parameters with lower sensitivity, this study aimed to compare perioperative profiles of a high-sensitive troponin T assay (hsTnT, Roche Diagnostics, Mannheim, Germany) with a troponin I assay (sTnI, Siemens Healthcare Diagnostics, Eschborn, Germany).


      A total of 287 consecutive patients undergoing a typical spectrum of cardiac procedures from August 2017 to March 2018 monitored with the hsTnT assay were compared with a propensity-matched collective analysed with the sTnI assay. For side-by side comparison, the peak troponin (Tmax) values were scaled to a z-score distribution before comparison.


      Despite absolute postoperative hsTnT and sTnI values differing by an order of magnitude, parameters could be scaled to a common distribution with kernel density curves overlapping 92%. Both parameters showed equal behaviour in subgroup analyses regarding relevant perioperative factors, such as type of procedure, cross-clamping time, and type of cardioplegic solution. However, there were some differences regarding pre-existing renal impairment between both parameters. In both groups, renal failure patients with chronic kidney disease stages IV or V as well as patients on haemodialysis exhibited a marked Tmax increase of >100% compared with normal kidney function (hsTnT, +121%; 2,383.5 vs 1,078.8 ng/L; p=0.0006; and sTnI, +149%; 27.3 ng/mL vs 11.0 ng/mL; p=0.009). However, in patients with moderately impaired renal function, those in the hsTnT group, but not in the sTnI cohort, showed significantly increased Tmax values (CKD stages II or III, 1,233.5 ng/L [+14%] and 1,314.1 ng/L [+22%] vs 1,078.8 ng/L; p=0.01 and p=0.03). In these patients, the postoperative interval until Tmax was reached was also significantly increased (14.4 and 19.0 hrs vs 12.4 hrs for chronic kidney disease stages II and III; p=0.0038 and p<0.001), indicating a higher rate of accumulation in the hsTnT parameter.


      In the context of cardiac surgery, this study found that both parameters behaved in a similar manner under most relevant circumstances. Despite significant difference in the absolute serum concentration, hsTnT and sTnI can be scaled to virtually identical distributions. However, renal impairment did affect both parameters differently with troponin T but not troponin I, showing evidence of accumulation in moderately impaired renal disease.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Javierre C.
        • Ricart A.
        • Manez R.
        • Farrero E.
        • Carrio M.L.
        • Rodriguez Castro D.
        • et al.
        Age and sex differences in perioperative myocardial infarction after cardiac surgery.
        Interact Cardiovasc Thorac Surg. 2012; 15: 28-32
        • Alexiou K.
        • Wilbring M.
        • Koch C.
        • Kappert U.
        • Tugtekin S.
        • Matschke K.
        Midterm follow-up of patients with perioperative myocardial infarction after coronary artery bypass surgery: clinical significance of different treatment strategies.
        Thorac Cardiovasc Surg. 2012; 60: 452-461
        • Wu A.H.
        • Feng Y.J.
        • Moore R.
        • Apple F.S.
        • McPherson P.H.
        • Buechler K.F.
        • et al.
        Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I. American Association for Clinical Chemistry Subcommittee on cTnI Standardization.
        Clin Chem. 1998; 44: 1198-1208
        • Apple F.S.
        • Collinson P.O.
        Analytical characteristics of high-sensitivity cardiac troponin assays.
        Clin Chem. 2012; 58: 54-61
        • Laugaudin G.
        • Kuster N.
        • Petiton A.
        • Leclercq F.
        • Gervasoni R.
        • Macia J.-C.
        • et al.
        Kinetics of high-sensitivity cardiac troponin T and I differ in patients with ST-segment elevation myocardial infarction treated by primary coronary intervention.
        Eur Heart J Acute Cardiovasc Care. 2016; 5: 354-363
        • Peivandi A.A.
        • Dahm M.
        • Opfermann U.T.
        • Peetz D.
        • Doerr F.
        • Loos A.
        • et al.
        Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction.
        Herz. 2004; 29: 658-664
        • Árnadóttir Á.
        • Vestergaard K.R.
        • Pallisgaard J.
        • Sölétormos G.
        • Steffensen R.
        • Goetze J.P.
        • et al.
        High-sensitivity cardiac troponin T is superior to troponin I in the prediction of mortality in patients without acute coronary syndrome.
        Int J Cardiol. 2018; 259: 186-191
        • Kozinski M.
        • Krintus M.
        • Kubica J.
        • Sypniewska G.
        High-sensitivity cardiac troponin assays: from improved analytical performance to enhanced risk stratification.
        Crit Rev Clin Lab Sci. 2017; 54: 143-172
        • Fan Y.
        • Jiang M.
        • Gong D.
        • Man C.
        • Chen Y.
        Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis.
        Biosci Rep. 2018; 38 (BSR20171178)
        • Fan Y.
        • Zhao X.
        • Li X.
        • Li N.
        • Hu X.
        Cardiac troponin and adverse outcomes in atrial fibrillation: a meta-analysis.
        Clin Chim Acta. 2018; 477: 48-52
        • Dalal J.J.
        • Ponde C.K.
        • Pinto B.
        • Srinivas C.N.
        • Thomas J.
        • Kumar Modi S.
        • et al.
        Time to shift from contemporary to high-sensitivity cardiac troponin in diagnosis of acute coronary syndromes.
        Indian Heart J. 2016; 68: 851-855
        • Anderson J.
        • Glynn L.G.
        Definition of chronic kidney disease and measurement of kidney function in original research papers: a review of the literature.
        Nephrol Dial Transplant. 2011; 26: 2793-2798
        • Markman P.L.
        • Tantiongco J.-P.
        • Bennetts J.S.
        • Baker R.A.
        High-sensitivity troponin release profile after cardiac surgery.
        Heart Lung Circ. 2017; 26: 833-839
        • Alyanakian M.A.
        • Dehoux M.
        • Chatel D.
        • Seguret C.
        • Desmonts J.M.
        • Durand G.
        • et al.
        Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery.
        J Cardiothorac Vasc Anesth. 1998; 12: 288-294
        • Mueller C.
        Biomarkers and acute coronary syndromes: an update.
        Eur Heart J. 2014; 35: 552-556
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • et al.
        Third universal definition of myocardial infarction.
        Eur Heart J. 2012; 33: 2551-2567
        • Rubini Gimenez M.
        • Twerenbold R.
        • Reichlin T.
        • Wildi K.
        • Haaf P.
        • Schaefer M.
        • et al.
        Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction.
        Eur Heart J. 2014; 35: 2303-2311
        • Freund Y.
        • Chenevier-Gobeaux C.
        • Bonnet P.
        • Claessens Y.-E.
        • Allo J.-C.
        • Doumenc B.
        • et al.
        High-sensitivity versus conventional troponin in the emergency department for the diagnosis of acute myocardial infarction.
        Crit Care. 2011; 15: R147
        • Kocak E.F.
        • Altuntas I.
        • Kocak C.
        • Aksoy A.
        • Ozdomanic I.F.
        • Isiklar O.O.
        • et al.
        High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery.
        Cardiovasc J Afr. 2015; 26: 234-241
        • Roffi M.
        • Patrono C.
        • Collet J.-P.
        • Mueller C.
        • Valgimigli M.
        • Andreotti F.
        • et al.
        2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2016; 37: 267-315
        • van Geene Y.
        • van Swieten H.A.
        • Noyez L.
        Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality.
        Interact Cardiovasc Thorac Surg. 2010; 10: 413-416
        • Biaz A.
        • Drissi M.
        • El Maataoui A.
        • Machtani Idrissi S.E.L.
        • Bouhsain S.
        • Dami A.
        • et al.
        Seuil de positivité de la troponine i cardiaque dans le diagnostic de l'IDM péri-opératoire après chirurgie cardiaque sous circulation extra-corporelle chez l'adulte.
        Pan Afr Med J. 2018; 29: 40
        • Mbagaya W.
        • Luvai A.
        • Lopez B.
        Biological variation of cardiac troponin in stable haemodialysis patients.
        Ann Clin Biochem. 2015; 52: 562-568
        • Aakre K.M.
        • Røraas T.
        • Petersen P.H.
        • Svarstad E.
        • Sellevoll H.
        • Skadberg O.
        • et al.
        Weekly and 90-minute biological variations in cardiac troponin T and cardiac troponin I in hemodialysis patients and healthy controls.
        Clin Chem. 2014; 60: 838-847
        • Needham D.M.
        • Shufelt K.A.
        • Tomlinson G.
        • Scholey J.W.
        • Newton G.E.
        Troponin I and T levels in renal failure patients without acute coronary syndrome: a systematic review of the literature.
        Can J Cardiol. 2004; 20: 1212-1218
        • Cubero-Gallego H.
        • Heredia-Rodriguez M.
        • Tamayo E.
        Influence of impairment in renal function on the accuracy of high-sensitivity cardiac troponin T for the diagnosis of perioperative myocardial infarction after heart valve surgery.
        Interact Cardiovasc Thorac Surg. 2018; 27: 234-237