Predictive value of high-sensitive troponin T to rule out acute rejection after heart transplantation.

time after HT (R = -0.49; P = .0001). The ROC curve of hs-TnT for detecting AR was 0.682 (95%CI, 0.54-0.81; P = .01). A hs-TnT concentration < 17 ng/L ruled out AR with a sensitivity and a negative predictive value of 100%, but a specificity of 13% (Table 2); there were 29 true negatives for AR with hs-TnT < 17 ng/L. In a mixed-effects logistic regression model, the hs-TnT values were log transformed and showed an OR = 1.58 (95%CI, 1.06-2.37; P = .026). This study suggests that hs-TnT concentrations < 17 ng/L may rule out AR with a sensitivity and negative predictive value of 100% (Table 2) and without obtaining false negatives. A noninvasive method to rule out AR may be useful in patients with contraindications to EMB and in those with insufficient material for histopathological study. Furthermore, a negative predictive value of 95% was observed at hs-TnT concentrations < 29 ng/L, which indicates that the probability of AR is low at hs-TnT concentrations of 17 ng/L to 29 ng/L. These concentrations are very close to the 99th percentile of the reference marker (14 ng/L) and to the upper limit of the confidence interval (24.9 ng/L) of this percentile, respectively (percentile reference range for hs-TnT; Roche Diagnostics package insert). Moreover, the histological detection of AR is limited because it does not distinguish between active and residual myocytolysis. The study data suggest that the measurement of hs-TnT concentrations can complement the histopathological diagnosis of AR. Thus, an ISHLT grade 2R associated with low hs-TnT concentrations may suggest a low or mild focal phenomenon; in