High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors
In brief
Over one-third of cancer patients on immunotherapy had high troponin T but normal troponin I
Among 433 patients starting immune checkpoint inhibitor therapy, 36.5% had elevated high-sensitivity troponin T but normal troponin I at baseline, and the pattern remained just as common one month later. The study excluded patients with myocarditis or myositis, and only 3.5% of deaths were cardiac, supporting troponin I as the more heart-specific test; paired baseline results may help interpret later elevations.
- Journal
- JACC. CardioOncology (Q1)
- Published
- 1 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Anis Ismail, Alexi Vasbinder, Bobby Bobby, McKenna de Bever, Aidan Vosooghi, Valeria Pena-Valentin, et al.
- PMID
- 42904625
- DOI
- 10.1016/j.jaccao.2026.07.012
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 23 October 2026): Directly compares troponin assay specificity and discordant results
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.