The role of high-sensitivity troponin in identifying patients with cardiac allograft rejection

Sep 30, 2026

High-sensitivity troponin I is used in many settings for surveillance after heart transplantation, yet its reliability for detecting clinically significant acute cellular rejection (ACR) remains uncertain. This retrospective cohort study analyzed electronic records of transplant recipients in Latin America, comparing HS-troponin I levels in biopsies with ACR grade greater than 2R versus lower grades using paired measurements. Results showed higher hs-TnI in ACR >2R, with ROC performance supporting its discriminatory value, including among patients with Chagas disease.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Background

Objective

Methods

Results

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[https://www.jhltopen.org/](https://www.jhltopen.org/) The role of high-sensitivity troponin in identifying patients with cardiac allograft rejection André A. Scussel,⁎, 1 Fabiana G. Marcondes-Braga, 1 Cristhian V. Espinoza Romero Daniel [C. de](C. de) Marchi Mônica Samuel Ávila Grinberg Fernanda Barone Alves do Santos Ana Maria Peixoto Cardoso Duque Sandrigo Mangini Luís Fernando Bernal Seguro Iáscara Wozniak Campos Fabio Gaiotto and Fernando Bacal Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil KEYWORDS: Heart transplantation; Acute cellular rejection; Cardiac biomarkers; High-sensitivity troponin; Endomyocardial biopsy BACKGROUND: Biomarkers for acute rejection diagnosis are frequently searched, and data from medical literature are conflicting. The role of high-sensitivity troponin I in the diagnosis of acute cellular rejection (ACR) after heart transplant (HT) is uncertain. However, it is a widely used and accessible tool in developing countries. OBJECTIVE: This study aims to determine whether hs-TnI can serve as a reliable and accessible tool to identify patients with clinically significant rejection (ACR > 2R) in a real-world Latin American cohort that has different etiologies than the epidemiology of the main trials. METHODS: In this retrospective cohort, we evaluated data from electronic records of HT recipients submitted to HT from March, 2020 to September, 2022 using REdCAp database. All patients who underwent endomyocardial biopsies (EMB) between 3 months and 2 years of HT and had samples of HS-troponin I previously measured were included in this study. The HS-troponin levels were compared between patients with ACR higher or lower than 2R. RESULTS: In this analysis, we included data from 187 biopsies performed at least 3 months after HT in 94 recipients who had paired Hs-troponin I samples collected. Fifty-four (57%) were men, and their median age at heart transplant was 48 ±11 years. The median hs-TnI levels were 29 (11-118) ng/L. ACR > 2R was observed in 48 EMB and the median hs-TnI levels were 69 (26-224) ng/L, which was significantly higher than levels observed in patients with grade 0R/1R [21 (9-64) ng/L, p < 0.001] . The ROC curve of hs-TnI shows an AUC of 0.705; p < 0.001 for the diagnosis of ACR > 2R. A cutoff of 19 ng/L showed a sensitivity of 88% and specificity of 49%, with a negative predictive value of 92% . Among biopsies from patients with Chagas disease (36.9% of the sample), hs-TnI also showed significant discriminatory power for ACR > 2R (p = 0.037) . CONCLUSION: In this cohort, HS-troponin I was able to identify patients with acute cellular rejection. This is the largest Latin American cohort assessing hs-TnI after HT, and the first to explore its performance across specific etiologies, including Chagas disease. Prospective studies may confirm the role of HS-troponin I as a biomarker of acute rejection. ⁎Corresponding author: André A. Scussel, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. E-mail address: [andrescussel@gmail.com](andrescussel@gmail.com). 1 contributed equally to this manuscript. 2950-1334/© 2025 The Authors. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). [https://doi.org/10.1016/j.jhlto.2025.100446](https://doi.org/10.1016/j.jhlto.2025.100446) JHLT Open 2026;11:100446 © 2025 The Authors. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license ([http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . Heart transplantation (HT) has become a life-saving therapeutic option for patients with end-stage heart failu

FAQs

What was the main objective of the study?

To determine whether high-sensitivity troponin I (hs-TnI) can reliably and accessibly identify patients with clinically significant acute cellular rejection (ACR > 2R) in a real-world Latin American cohort.

How was hs-TnI evaluated in relation to ACR grade?

The study retrospectively compared hs-TnI levels between patients with ACR higher than 2R and those with ACR 2R or lower, using paired samples measured prior to endomyocardial biopsy.

What threshold performance did hs-TnI show for diagnosing ACR > 2R?

A cutoff of 19 ng/L yielded sensitivity of 88% and specificity of 49%, with a negative predictive value of 92%.

Did hs-TnI perform differently in patients with specific etiologies?

In biopsies from patients with Chagas disease, hs-TnI still showed significant discriminatory power for ACR > 2R (p = 0.037).

Sep 30, 2026

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