scholarly journals Highly Sensitive Troponin Assays and the Cardiology Community: A Love/Hate Relationship?

2011 ◽  
Vol 57 (6) ◽  
pp. 826-829 ◽  
Author(s):  
James A de Lemos ◽  
David A Morrow ◽  
Christopher R deFilippi
Keyword(s):  
Cardiac Troponin ◽  
Cardiovascular Health ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Injury ◽  
Improve Patient Care ◽  
Fourth Generation ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Improve Patient

Abstract The development of highly sensitive assays for cardiac troponin T (hs-cTnT)4 and cardiac troponin I (hs-cTnI) represents the latest technological advance in a field that has witnessed continual progression toward more sensitive and more precise tools for detecting cardiac injury. The hs-cTnT assay, for example, can detect cTnT concentrations 10-fold lower than the current fourth-generation assay, with high precision at the myocardial infarction (MI) detection limit. Despite the potential for such evolution to improve patient care, clinicians, including practicing cardiologists, often find themselves poorly prepared for the introduction of more-sensitive assays, because they fail to consider the implications of increasing sensitivity on the interpretation of the test results. We believe that highly sensitive troponin assays offer new opportunities to improve cardiovascular health, but they also present challenges in the areas in which troponin testing is most commonly used today.

scholarly journals The value of highly sensitive troponin in the early diagnosis of acute myocardial infarction.

2018 ◽  
Vol 96 (1) ◽  
pp. 25-29
Author(s):  
N. N. Borovkov ◽  
Natalya A. Golitsyna
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Early Diagnosis ◽  
Diagnostic Accuracy ◽  
Clinical Significance ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Sensitivity Specificity

Aim. Study the immediate clinical significance of determination of highly sensitive troponin (high sensitive cardiac troponin - hscTn) in the early diagnosis of acute myocardial infarction (AMI). Material and methods. The analysis of nosological diagnosis in 92 patients with acute coronary syndrome (ACS), urgently hospitalized in the coronary care unit of the Nizhny Novgorod regional hospital. N.A. Semashko. The time from the moment of development of pain syndrome, hospitalization in a hospital ranged from 40 minutes to 4 hours, averaging 2.5 ± 0.32 hours. During hospitalization of patients in the complex diagnosis of AMI in addition to General clinical examination, ECG was determined by the content hscTn and troponin I. All patients in the hospital was performed selective coronary angiography (SCG). Evaluated the sensitivity, specificity and diagnostic accuracy hscTn in comparison with troponin I. Analysis results were represented as a percentage and using a software package "STATISTICA 10.0" (StatSoft, Inc., USA). Results. AMI is diagnosed in 74% of cases (n=68), and the rest 26% (n=24) unstable (progressive) angina (NS). Transmural myocardial infarction or Q-wave myocardial infarction detected in 54% (n=37) of patients. Intramural myocardial infarction or non Q-wave myocardial infarction - in 46% (n=31). AMI re-seen in 27% (n=18). Importance of the study of both cardiac troponin in the early diagnosis of AMI showed the following. Sensitivity hscTn reached 98%, while troponin I - 88%. Specificity hscTn was 79%, and troponin I, only 66%. Overall diagnostic accuracy hscTn was 92%, troponin I less - 83%). Conclusion. The results of the study indicate a predominant clinical significance hscTn in comparison with troponin I in early diagnosis of AMI in the parameters of sensitivity, specificity and diagnostic accuracy.

scholarly journals Cardiac Troponins Following Repeated Administration of an Iron Chelator – Salicylaldehyd Isonicotinoyl Hydrazone (SIH) – in Rabbits

2003 ◽  
Vol 46 (4) ◽  
pp. 171-174 ◽  
Author(s):  
Michaela Adamcová ◽  
Martin Štěrba ◽  
Ivona Klimtová ◽  
Tomáš Šimůnek ◽  
Radomír Hrdina ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Injury ◽  
Repeated Administration ◽  
Iron Chelator ◽  
Laboratory Animals ◽  
Coefficient Of Determination ◽  
Control Group

Both cardiac troponin T (cTnT) and cardiac troponin I (cTnI) are considered to be reliable biomarkers with sufficient sensitivity and specificity for cardiac injury in the majority of laboratory animals. The aim of our study was to compare the diagnostic performance of cTnT and cTnI in three groups of rabbits: 1) control (saline 1 ml/kg i.v.); 2) Salicylaldehyd Isonicotinoyl Hydrazone – SIH (50 mg/kg, once weekly, i.p.; partially dissolved in 10 % Cremophor solution); 3) 10 % Cremophor solution in water (2 ml/kg i.v.). The drugs were given once a week, 10 administrations. The concentration of cTnT was measured using Elecsys Troponin T STAT Immunoassay (Roche). The concentration of cTnI was measured using AxSYM Troponin I (Abbott). The linear regression model was applied to see if there is a dependence between cTnT and cTnI. The coefficient of determination was not acceptable in all groups. The highest value of R2was found in the control group (R2= 0.424). We may conclude that in rabbits meaningful dependence between cTnT and cTnI was not found. According to our long-term experiences cTnT seems to be more suitable cardiomarker in rabbits in comparison with cTnI where the data are characterized by the large scatter.

scholarly journals Cardiac Troponin I Seems to Be Superior to Cardiac Troponin T in the Early Detection of Cardiac Injury Associated with Anthracycline Treatment

Onkologie ◽  
2008 ◽  
Vol 31 (10) ◽  
pp. 12-12 ◽  
Author(s):  
Jan M. Horacek ◽  
Radek Pudil ◽  
Milos Tichy ◽  
Ladislav Jebavy ◽  
Alena Strasova ◽  
...  
Keyword(s):  
Early Detection ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Injury ◽  
Cardiac Troponin I ◽  
Cardiac Troponin T

scholarly journals Discordance with 3 Cardiac Troponin I and T Assays: Implications for the 99th Percentile Cutoff

2016 ◽  
Vol 62 (8) ◽  
pp. 1106-1114 ◽  
Author(s):  
Jacobus Petrus Johannes Ungerer ◽  
Jillian Russyll Tate ◽  
Carel Jacobus Pretorius
Keyword(s):  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Reference Intervals ◽  
Cardiac Troponin I ◽  
Poor Correlation ◽  
Highly Sensitive ◽  
Analytical Imprecision ◽  
Abbott Architect ◽  
High Sensitive Troponin

Abstract BACKGROUND We compared the 99th percentile reference intervals with 3 modern cardiac troponin assays in a single cohort and tested the hypothesis that the same individuals will be identified as above the cutoff and that differences will be explained by analytical imprecision. METHODS Blood was collected from 2005 apparently healthy blood donors. Cardiac troponin was measured with Abbott Architect STAT high sensitive troponin I, Beckman Coulter Access AccuTnI+3, and Roche Elecsys troponin T highly sensitive assays. RESULTS The 99th percentile cutoff limits were as follows: Abbott cardiac troponin I (cTnI) 28.9 ng/L; Beckman Coulter cTnI 31.3 ng/L; and Roche cardiac troponin T (cTnT) 15.9 ng/L. Correlation among the assays was poor: Abbott cTnI vs Beckman Coulter cTnI, R2 = 0.18; Abbott cTnI vs Roche cTnT, R2 = 0.04; and Beckman Coulter cTnI vs Roche cTnT R2 = 0.01. Of the results above the cutoff 50% to 70% were unique to individual assays, with only 4 out of 20 individuals above the cutoff for all 3 assays. The observed differences among assays were larger than predicted from analytical imprecision. CONCLUSIONS The 99th percentile cutoff values were in agreement with those reported elsewhere. The poor correlation and concordance amongst the assays were notable. The differences found could not be explained by analytical imprecision and indicate the presence of inaccuracy (bias) that is unique to sample and assay combinations. Based on these findings we recommend less emphasis on the cutoff value and greater emphasis on δ values in the diagnosis of myocardial infarction.

scholarly journals Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index

2011 ◽  
Vol 106 (11) ◽  
pp. 978-984 ◽  
Author(s):  
David Spirk ◽  
Drahomir Aujesky ◽  
Marc Husmann ◽  
Daniel Hayoz ◽  
Thomas Baldi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Characteristic Curve ◽  
Early Death ◽  
Severity Index ◽  
Highly Sensitive ◽  
Risk Patients ◽  
Highly Sensitive Troponin

SummaryA low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ≤80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38–8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76–44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63–0.81) than sPESI alone (HR 0.63, 95% CI 0.57–0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.

scholarly journals Troponins in scuba divers with immersion pulmonary edema

2018 ◽  
Vol 38 (5) ◽  
Author(s):  
Marion Marlinge ◽  
Pierre Deharo ◽  
Fabrice Joulia ◽  
Mathieu Coulange ◽  
Donato Vairo ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Myocardial Injury ◽  
Creatine Phosphokinase ◽  
Troponin I ◽  
Troponin T ◽  
Water Immersion ◽  
Scuba Divers ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Tomography Scan

Immersion pulmonary edema (IPE) is a serious complication of water immersion during scuba diving. Myocardial ischemia can occur during IPE that worsens outcome. Because myocardial injury impacts the therapeutic management, we aim to evaluate the profile of cardiac markers (creatine phosphokinase (CPK), brain natriuretic peptide (BNP), highly sensitive troponin T (TnT-hs) and ultrasensitive troponin I (TnI-us) of divers with IPE. Twelve male scuba divers admitted for suspected IPE were included. The collection of blood samples was performed at hospital entrance (T0) and 6 h later (T0 + 6 h). Diagnosis was confirmed by echocardiography or computed-tomography scan. Mean ± S.D. BNP (pg/ml) was 348 ± 324 at T0 and 223 ± 177 at T0 + 6 h (P<0.01), while mean CPK (international units (IUs)), and mean TnT-hs (pg/ml) increased in the same times 238 ± 200 compared with 545 ± 39, (P=0.008) and 128 ± 42 compared with 269 ± 210, (P=0.01), respectively; no significant change was observed concerning TnI-us (pg/ml): 110 ± 34 compared with 330 ± 77, P=0.12. At T0 + 6 h, three patients had high TnI-us, while six patients had high TnT-hs. Mean CPK was correlated with TnT-hs but not with TnI-us. Coronary angiographies were normal. The increase in TnT during IPE may be secondary to the release of troponin from non-cardiac origin. The measurement of TnI in place of TnT permits in some cases to avoid additional examinations, especially unnecessary invasive investigations.

scholarly journals Reference Population and Marathon Runner Sera Assessed by Highly Sensitive Cardiac Troponin T and Commercial Cardiac Troponin T and I Assays

2009 ◽  
Vol 55 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Alma Mingels ◽  
Leo Jacobs ◽  
Etienne Michielsen ◽  
Joost Swaanenburg ◽  
Will Wodzig ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin I ◽  
Limit Of Detection ◽  
Troponin T ◽  
Reference Population ◽  
Clinical Implications ◽  
Cardiac Troponin T ◽  
Low Concentrations ◽  
Highly Sensitive ◽  
Almost All

Abstract Background: Endurance exercise can increase cardiac troponin (cTn) concentrations as high as those seen in cases of minor myocardial infarction. The inability of most cTn assays to reliably quantify cTn at very low concentrations complicates a thorough data analysis, and the clinical implications of such increases remain unclear. The application of recently developed highly sensitive cTn immunoassays may help resolve these problems. Methods: We evaluated the precommercial highly sensitive cardiac troponin T (hs-cTnT) assay from Roche Diagnostics and the Architect cardiac troponin I (cTnI-Architect) assay from Abbott Diagnostics by testing samples from a reference population of 546 individuals and a cohort of 85 marathon runners. We also measured the samples with the current commercial cTnT assay for comparison. Results: Although the hs-cTnT and cTnI-Architect assays were capable of measuring cTn concentrations at low concentrations (&lt;0.01 μg/L), only the hs-cTnT assay demonstrated a CV of &lt;10% at the 99th percentile of the reference population and a near-gaussian distribution of the measurements. After a marathon, 86% of the runners had cTnT concentrations greater than the 99th percentile with the hs-cTnT assay, whereas only 45% of the runners showed increased concentrations with the current cTnT assay. cTn concentrations remained significantly increased the day after the marathon. A multiple regression analysis demonstrated marathon experience and age to be significant predictors of postmarathon cTn concentrations (P &lt; 0.05). Conclusions: The hs-cTnT assay was the only assay tested with a performance capability sufficient to detect cTn concentrations in healthy individuals. The number of runners with increased cTn concentrations after a marathon depends highly on an assay’s limit of detection (LOD). The assay with the lowest LOD, the hs-cTnT assay, showed that almost all runners had increased cTn concentrations. The clinical implications of these findings require further investigation.

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