Work

High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors

Year: 2026

Type: article

Abstract: BACKGROUND: Serial troponin monitoring is used during immune checkpoint inhibitor (ICI) therapy, but guidelines do not specify whether high-sensitivity cardiac troponin I (hs-cTnI) or T (hs-cTnT) should be measured. Unlike cardiac-specific hs-cTnI, hs-cTnT can rise from noncardiac sources. OBJECTIVES: This study sought to determine the prevalence and temporal stability of hs-cTnT/hs-cTnI discordance, identify clinical correlates, and evaluate prognostic implications in ambulatory ICI-treated patients. METHODS: In this prospective single-center cohort, patients starting ICI therapy underwent paired hs-cTnT (Roche Elecsys) and hs-cTnI (Siemens Atellica) measurements in the same banked samples at baseline and 1 month. Patients with adjudicated ICI-associated myocarditis or myositis were excluded by design. RESULTS: Among 433 patients with paired baseline measurements, hs-cTnT was elevated in 37.9% and hs-cTnI in 1.8%; 158 (36.5%) were discordant (elevated hs-cTnT, normal hs-cTnI), and 267 (61.7%) had normal levels of both (κ = 0.036). Among 329 patients with paired data at baseline and 1 month, discordance prevalence was unchanged (38.3% vs 38.0%; McNemar P > 0.99). Independent correlates were older age, male sex, and chronic kidney disease (all P < 0.05). Over a median follow-up of 30.1 months (reverse Kaplan-Meier), elevated hs-cTnT was associated with all-cause mortality (adjusted HR: 1.35; 95% CI: 1.00-1.81; P = 0.048); only 8 of 231 deaths (3.5%) were cardiac. CONCLUSIONS: 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.

Source: JACC CardioOncology

DOI: 10.1016/j.jaccao.2026.07.012