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Kavsak PA, Khattak S, Pogue E, Tandon V. An interference yielding divergent high-sensitivity cardiac troponin results on different instruments from the same manufacturer. Clin Chim Acta 2023; 548:117450. [PMID: 37348628 DOI: 10.1016/j.cca.2023.117450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
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Brinc D, Vandenberghe H, Kulasingam V, Kavsak PA. Discrepant high-sensitivity cardiac troponin I concentrations when measured on the Abbott Alinity ci versus the Abbott Architect system. Clin Chim Acta 2022; 537:105-106. [PMID: 36228678 DOI: 10.1016/j.cca.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Davor Brinc
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | | | - Vathany Kulasingam
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Chaulin AM. On the Effect of Heterophilic Antibodies on Serum Levels of Cardiac Troponins: A Brief Descriptive Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081114. [PMID: 35892916 PMCID: PMC9394338 DOI: 10.3390/life12081114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022]
Abstract
Serum levels of cardiac troponins can be increased both with myocardial damage and in the absence of myocardial damage. In the second case, this is due to the influence of false-positive factors, among which heterophilic antibodies play a significant role. Understanding the causes of the formation of heterophilic antibodies, the features and mechanisms of their effect on serum levels of cardiac troponins, is an important condition for interpreting a false-positive result due to the influence of heterophilic antibodies. This brief, descriptive review presents the causes of heterophilic-antibodies formation and discusses their effect on serum levels of cardiac troponins.
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
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Storage conditions, sample integrity, interferences, and a decision tool for investigating unusual high-sensitivity cardiac troponin results. Clin Biochem 2022; 115:67-76. [PMID: 35772501 DOI: 10.1016/j.clinbiochem.2022.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
The current definition of high-sensitivity cardiac troponin (hs-cTn) assays is laboratory-based and their analytical attributes and characteristics have drawn significant attention in the literature at least partly due to the lower concentration cut-offs and changes in concentrations (i.e., deltas) employed in different algorithms and pathways to manage patient care. We propose that pre-analytical conditions such as sample type, storage conditions, and other interferences may also have a significant impact on hs-cTn concentrations and clinical management. The purpose of this literature review is to provide a summary of important pre-analytical and interference studies affecting hs-cTn concentrations. A breakdown of the literature for the major diagnostic companies providing core laboratory instrumentation (i.e., Abbott, Beckman, Ortho, Roche, and Siemens) is also provided. Finally, three cases are highlighted where knowledge of pre-analytical factors aids the hs-cTn clinically discordant investigations. This review highlights the importance of pre-analytical variables, especially storage condition, sample handling, and blood tubes used (i.e., sample type) when interpreting hs-cTn assays. Additional studies are needed to further elaborate on pre-analytical variables (i.e., centrifugation, sample type, stability) and interferences for all hs-cTn assays in clinical use, as knowledge of these variables may aid in hs-cTn clinically discordant investigations.
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Kavsak PA, Clark L, Martin J, Mark CT, Paré G, Mondoux S, Chetty VT, Ainsworth C, Worster A. Acute Phase Response and Non-Reproducible Elevated Concentrations with a High-Sensitivity Cardiac Troponin I Assay. J Clin Med 2021; 10:1014. [PMID: 33801415 PMCID: PMC7958626 DOI: 10.3390/jcm10051014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
High-sensitivity cardiac troponin (hs-cTn) testing has enabled physicians to make earlier diagnostic and prognostic decisions in the hospital setting than previous cardiac troponin assays. Analytical improvements have permitted one to measure cardiac troponin precisely in the nanogram per litre (ng/L) range with hs-cTn assays which has resulted in fast 0/1-h and 0/2-h algorithms for ruling-in and ruling-out myocardial infarction. Although analytical interferences that affect the reporting of hs-cTn are uncommon, not all hs-cTn assays are designed the same nor have undergone the same clinical and analytical validations. Here, after investigating an initial case of discrepant hs-cTnI results, we report that patients with an acute phase response (e.g., patients with inflammatory or infectious illnesses) can yield high and non-reproducible results with the Ortho Clinical Diagnostics hs-cTnI assay. Compared to Abbott Diagnostics hs-cTnI, Ortho Clinical Diagnostics hs-cTnI assay misclassifies biochemical injury in approximately 10% of the population being assessed for myocardial injury with imprecise results in approximately half of this population (i.e., 5%). In conclusion, caution is warranted in interpreting Ortho Clinical Diagnostics hs-cTnI alone in patients being evaluated for myocardial injury, especially in patients whose primary presentation is related to an acute phase response and not an acute coronary syndrome symptom.
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Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (G.P.); (V.T.C.)
- Core Laboratory, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON L8V 1C3, Canada; (L.C.); (C.-T.M.)
| | - Lorna Clark
- Core Laboratory, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON L8V 1C3, Canada; (L.C.); (C.-T.M.)
| | - Janet Martin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (G.P.); (V.T.C.)
| | - Ching-Tong Mark
- Core Laboratory, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON L8V 1C3, Canada; (L.C.); (C.-T.M.)
| | - Guillaume Paré
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (G.P.); (V.T.C.)
| | - Shawn Mondoux
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.); (A.W.)
| | - V. Tony Chetty
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (G.P.); (V.T.C.)
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Andrew Worster
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.); (A.W.)
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Abstract
The measurement of cardiac troponin (cTn) is recommended by all guidelines as the gold standard for the differential diagnosis of Acute Coronary Syndromes. The aim of this review is to discuss in details some key issues regarding both analytical and clinical characteristics of the high-sensitivity methods for cTn (hs-cTn), which are still considered controversial or unresolved. In particular, the major clinical concern regarding hs-cTn methods is the difficulty to differentiate the pathophysiological mechanism responsible for biomarker release from cardiomyocytes after reversible or irreversible injury, respectively. Indeed, recent experimental and clinical studies have demonstrated that different circulating forms of cTnI and cTnT can be respectively measured in plasma samples of patients with reversible or irreversible myocardial injury. Accordingly, a new generation of hs-Tn methods should be set up, based on immunometric immunoassays or chromatographic techniques, specific for circulating peptide forms more characteristics for reversible or irreversible myocardial injury. It is conceivable that this new generation of hs-cTn methods will complete the mission regarding the laboratory tests for specific cardiac biomarkers, started more than 20 years ago, which has already revolutionized the diagnosis, prognosis and management of patients with cardiac diseases.
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