High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors (JACC: CardioOncology State-of-the-Art Review October 2026)-Article: High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors

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

Pdf Summary

This prospective single-center study assessed paired high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) in 433 ambulatory patients starting immune checkpoint inhibitor (ICI) therapy. Patients with adjudicated ICI-associated myocarditis or myositis were excluded.<br /><br />At baseline, hs-cTnT was elevated in 37.9% of patients, compared with 1.8% for hs-cTnI. More than one-third had elevated hs-cTnT with normal hs-cTnI, while both markers were normal in 61.7%. This discordance was already present before ICI exposure and remained stable at one month. Older age, male sex, and chronic kidney disease were independently associated with discordance. The pattern is consistent with chronic noncardiac influences, such as skeletal-muscle expression or reduced renal clearance, although these mechanisms were not directly measured.<br /><br />Over a median 30-month follow-up, elevated hs-cTnT was modestly associated with all-cause mortality; hs-cTnI elevation was not, but few patients had elevated hs-cTnI and only eight deaths were cardiac. The authors suggest hs-cTnI is more cardiac-specific and that measuring both troponins before treatment may help interpret later results when myocarditis is suspected. Findings are limited by the single-center design, use of one assay platform for each marker, and few cardiac events; they do not establish which assay is more sensitive for detecting myocarditis.

Meta Tag

Concept High-Sensitivity Troponin I

Concept hs-cTnT-gen6 ESC algorithm

Concept Troponin Discordance

Concept Cardiac Specificity

Concept Troponin Surveillance

Keywords

high-sensitivity cardiac troponin T

high-sensitivity cardiac troponin I

immune checkpoint inhibitor therapy

baseline biomarker discordance

cardiac biomarkers

myocarditis

myositis

chronic kidney disease

all-cause mortality

single-center study

High-Sensitivity Troponin I

hs-cTnT-gen6 ESC algorithm

Troponin Discordance

Cardiac Specificity

Troponin Surveillance