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Peer-reviewedCC BY 4.0JACC: CardioOncology

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

  • Anis Ismail1
  • Alexi Vasbinder2
  • Bobby Bobby3
  • McKenna de Bever3
  • Aidan Vosooghi4
  • Valeria Pena-Valentin5
  • Lihua Shu4
  • Sujay Kalathoor4
  • Ramya Elangovan1
  • Rachel Jones5
  • Julia Skibniewska5
  • Ian Pizzo5
5 more authors
  • Tonimarie Catalan5
  • Theresa Farhat1
  • Pennelope Kunkle1
  • Monika Leja5
  • Salim S. Hayek1,5
5 affiliations
  1. 1Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
  2. 2School of Nursing, University of Washington, Seattle, Washington, USA
  3. 3John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
  4. 4Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Division of Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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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.

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Cite

BibTeXRIS
BibTeX
@article{ismail2026highsensitivity,
  title = {{High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors}},
  author = {Anis Ismail and Alexi Vasbinder and Bobby Bobby and McKenna de Bever and Aidan Vosooghi and Valeria Pena-Valentin and Lihua Shu and Sujay Kalathoor and Ramya Elangovan and Rachel Jones and Julia Skibniewska and Ian Pizzo and Tonimarie Catalan and Theresa Farhat and Pennelope Kunkle and Monika Leja and Salim S. Hayek},
  journal = {JACC: CardioOncology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jaccao.2026.07.012},
  url = {https://doi.org/10.1016/j.jaccao.2026.07.012},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - High-Sensitivity Cardiac Troponin T and I Discordance in Patients Receiving Immune Checkpoint Inhibitors
AU  - Anis Ismail
AU  - Alexi Vasbinder
AU  - Bobby Bobby
AU  - McKenna de Bever
AU  - Aidan Vosooghi
AU  - Valeria Pena-Valentin
AU  - Lihua Shu
AU  - Sujay Kalathoor
AU  - Ramya Elangovan
AU  - Rachel Jones
AU  - Julia Skibniewska
AU  - Ian Pizzo
AU  - Tonimarie Catalan
AU  - Theresa Farhat
AU  - Pennelope Kunkle
AU  - Monika Leja
AU  - Salim S. Hayek
PY  - 2026
DA  - 2026/10/01
JO  - JACC: CardioOncology
DO  - 10.1016/j.jaccao.2026.07.012
UR  - https://doi.org/10.1016/j.jaccao.2026.07.012
AB  - 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.
SN  - 2666-0873
ER  -