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Concentration of hs-Troponin in small cohort of transgender patients. Clin Chim Acta 2023; 539:66-69. [PMID: 36495928 DOI: 10.1016/j.cca.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Sex-differences in high sensitivity troponin (hs-Tn) concentrations are well established. There is, however, limited data to guide interpretation of hs-Tn in transgender patients, particularly those receiving gender-affirming hormone therapy. Our purpose was to evaluate troponin testing in transgender patients. METHODS Transgender adults attending a routine clinic visit provided demographic data, medical history, and venous blood samples. Patients with congestive heart failure or chronic kidney disease were excluded. hs-Tn was measured using the Architect Stat High Sensitivity Troponin-I (Abbott), Access 2 hsTnI (Beckman Coulter), and Elecsys Troponin T Gen 5 STAT (Roche) assays. hs-Tn below the limit of detection (LOD) is reported as the lower limit of detection (LLOD) RESULTS: Of 63 subjects, 76 % were transgender women. We found no significant difference in median hs-Tn concentrations or proportions of hs-Tn > LOD. CONCLUSION In this cohort of stable transgender patients without CHF or CKD, we did not observe differences in hs-Tn concentrations between transgender women and transgender men. Meaningful conclusions are limited owing to inadequate sample size and population differences. Further research on hs-troponin concentrations in this underrepresented, vulnerable population is needed.
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Ahn S, Kim HK, Lee W, Chun S, Min WK. Effect of Outlier Elimination on the 99th Percentile Upper Reference Limits of High-Sensitivity Cardiac Troponin I Assays Based on a Strictly Selected Healthy Reference Population. Ann Lab Med 2022; 42:331-341. [PMID: 34907103 PMCID: PMC8677476 DOI: 10.3343/alm.2022.42.3.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/13/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background We established high-sensitivity cardiac troponin I (hsTnI) 99th percentile upper reference limits (URLs) for the Centaur XPT High-Sensitivity Troponin I assay (Centaur hsTnI; Siemens, Erlangen, Germany) and Atellica IM High-Sensitivity Troponin I assay (Atellica hsTnI; Siemens) and assessed the effect of outlier elimination. Methods The reference population comprised 380 men and 387 women, satisfying the strict systematic reference population criteria. After reference population verification by the N-terminal pro-B-type natriuretic peptide (NT-proBNP) assay, 99th percentile URLs for Centaur hsTnI and Atellica hsTnI were calculated before and after outlier elimination. Results The 99th percentile URL for Centaur hsTnI was 60.4 (men, 74.7; women, 57.5) ng/L and that for Atellica hsTnI was 59.6 (men, 75.2; women, 55.1) ng/L. After the elimination of 61 (8.0%) outlier samples in Centaur hsTnI and 58 (7.6%) in Atellica hsTnI, the 99th percentile URLs were 13.5 ng/L (men, 15.3 ng/L; women, 11.9 ng/L) and 13.4 ng/L (men, 15.5 ng/L; women, 12.9 ng/L), respectively, significantly lower than those before outlier elimination. The CVs at the 99th percentile URLs were 5.2% and 3.5%, respectively. The measurable fractions among the reference population were 91.5% and 93.4%, respectively. Performance evaluation of Atellica B-type natriuretic peptide (BNP), Atellica NT-proBNP, Centaur hsTnI, and Atellica hsTnI showed outstanding results. Conclusions The Korean hsTnI 99th percentile URLs calculated in this study were significantly lower after outlier elimination than before. Centaur hsTnI and Atellica hsTnI meet the "Guideline acceptable" and "Level 3 (second generation, high sensitivity)" requirements, satisfying international standards.
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Affiliation(s)
- Sunyoung Ahn
- Department of Laboratory Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Hyun-Ki Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sail Chun
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Cho H, Kim H, Lee J, Kim SY, Lee HK, Kwon HJ, Kim Y. Frequency histograms of three high-sensitivity cardiac troponin assays in a reference population. J Clin Lab Anal 2022; 36:e24432. [PMID: 35441734 PMCID: PMC9169213 DOI: 10.1002/jcla.24432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/07/2022] Open
Abstract
Background Cardiac troponin (cTn) values above the 99th percentile upper reference limit (URL) indicate myocardial injury. We established 99th percentile URLs for three high‐sensitivity cTn (hs‐cTn) assays (Beckman Coulter Access hs‐cTnI, Abbott STAT hs‐cTnI, and Roche Elecsys hs‐cTnT) using a healthy population in Korea. Methods Each cTn value was measured by three assays and analyzed by dividing by gender and age. Results The frequency histograms of log‐transformed cTn values for Beckman and Abbott assays exhibited a bell‐shaped distribution. The 99th percentile URLs were 9.8, 17.4, and 17.3 ng/L in the total population; 10.9/9.0, 18.9/17.0, and 18.9/17.7 ng/L in the male/female population (p < 0.001 for all three assays); and 11.2/7.2, 19.9/14.5, and 22.7/9.3 ng/L in the older/younger population (p < 0.001 for all three assays) for Beckman, Abbott, and Roche assays, respectively. Conclusion Among the three assays, bell‐shaped distributions were observed in a frequency histogram of log‐transformed cTn values for healthy population in Beckman and Abbott assays. Also, our findings show that the 99th percentile URLs for cTn levels vary not only by gender but age.
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Affiliation(s)
- Hanwool Cho
- Department of Laboratory Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunjung Kim
- Department of Laboratory Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Young Kim
- Department of Laboratory Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Kyung Lee
- Department of Laboratory Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hi Jeong Kwon
- Department of Laboratory Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeongsic Kim
- Department of Laboratory Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kang T, Kim GS, Byun YS, Kim J, Kim S, Chang J, Yoo SJ. An Algorithmic Approach Is Superior to the 99th Percentile Upper Reference Limits of High Sensitivity Troponin as a Threshold for Safe Discharge from the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1083. [PMID: 34684124 PMCID: PMC8540893 DOI: 10.3390/medicina57101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: High-sensitivity cardiac troponin I (hs-TnI) is an important indicator of acute myocardial infarction (AMI) among patients presenting with chest discomfort at the emergency department (ED). We aimed to determine a reliable hs-TnI cut-off by comparing various values for a baseline single measurement and an algorithmic approach. Materials and Methods: We retrospectively reviewed the hs-TnI values of patients who presented to our ED with chest discomfort between June 2019 and June 2020. We evaluated the diagnostic accuracy of AMI with the Beckman Coulter Access hs-TnI assay by comparing the 99th percentile upper reference limits (URLs) based on the manufacturer's claims, the newly designated URLs in the Korean population, and an algorithmic approach. Results: A total of 1296 patients who underwent hs-TnI testing in the ED were reviewed and 155 (12.0%) were diagnosed with AMI. With a single measurement, a baseline hs-TnI cut-off of 18.4 ng/L showed the best performance for the whole population with a sensitivity of 78.7%, specificity of 95.7%, negative predictive value (NPV) of 97.1%, and positive predictive value (PPV) of 71.3%. An algorithm using baseline and 2-3 h hs-TnI values showed an 100% sensitivity, 97.7% specificity, an NPV of 100%, and a PPV of 90.1%. This algorithm used a cut-off of <4 ng/L for a single measurement 3 h after symptom onset or an initial level of <5 ng/L and a change of <5 ng/L to rule a patient out, and a cut-off of ≥50 ng/L for a single measurement or a change of ≥20 ng/L to rule a patient in. Conclusions: The algorithmic approach using serial measurements could help differentiate AMI patients from patients who could be safely discharged from the ED, ensuring that patients were triaged accurately and did not undergo unnecessary testing. The cut-off values from previous studies in different countries were effective in the Korean population.
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Affiliation(s)
- Taekyung Kang
- Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea;
| | - Gwang Sil Kim
- Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (G.S.K.); (Y.S.B.)
| | - Young Sup Byun
- Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (G.S.K.); (Y.S.B.)
| | - Jongwoo Kim
- Health Promotion Center and Family Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea;
| | - Sollip Kim
- Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea; (S.K.); (J.C.)
| | - Jeonghyun Chang
- Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea; (S.K.); (J.C.)
| | - Soo Jin Yoo
- Laboratory Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea
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Brandmeier JC, Raiko K, Farka Z, Peltomaa R, Mickert MJ, Hlaváček A, Skládal P, Soukka T, Gorris HH. Effect of Particle Size and Surface Chemistry of Photon-Upconversion Nanoparticles on Analog and Digital Immunoassays for Cardiac Troponin. Adv Healthc Mater 2021; 10:e2100506. [PMID: 34263562 DOI: 10.1002/adhm.202100506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/22/2021] [Indexed: 12/26/2022]
Abstract
Sensitive immunoassays are required for troponin, a low-abundance cardiac biomarker in blood. In contrast to conventional (analog) assays that measure the integrated signal of thousands of molecules, digital assays are based on counting individual biomarker molecules. Photon-upconversion nanoparticles (UCNP) are an excellent nanomaterial for labeling and detecting single biomarker molecules because their unique anti-Stokes emission avoids optical interference, and single nanoparticles can be reliably distinguished from the background signal. Here, the effect of the surface architecture and size of UCNP labels on the performance of upconversion-linked immunosorbent assays (ULISA) is critically assessed. The size, brightness, and surface architecture of UCNP labels are more important for measuring low troponin concentrations in human plasma than changing from an analog to a digital detection mode. Both detection modes result approximately in the same assay sensitivity, reaching a limit of detection (LOD) of 10 pg mL-1 in plasma, which is in the range of troponin concentrations found in the blood of healthy individuals.
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Affiliation(s)
- Julian C. Brandmeier
- Institute of Analytical Chemistry, Chemo‐ and Biosensors University of Regensburg Regensburg 93053 Germany
| | - Kirsti Raiko
- Department of Life Technologies/Biotechnology University of Turku Kiinamyllynkatu 10 Turku 20520 Finland
| | - Zdeněk Farka
- Institute of Analytical Chemistry, Chemo‐ and Biosensors University of Regensburg Regensburg 93053 Germany
- Department of Biochemistry, Faculty of Science Masaryk University Kamenice 5 Brno 625 00 Czech Republic
| | - Riikka Peltomaa
- Institute of Analytical Chemistry, Chemo‐ and Biosensors University of Regensburg Regensburg 93053 Germany
- Department of Life Technologies/Biotechnology University of Turku Kiinamyllynkatu 10 Turku 20520 Finland
| | - Matthias J. Mickert
- Institute of Analytical Chemistry, Chemo‐ and Biosensors University of Regensburg Regensburg 93053 Germany
| | - Antonín Hlaváček
- Institute of Analytical Chemistry of the Czech Academy of Sciences v. v. i. Brno 602 00 Czech Republic
| | - Petr Skládal
- Department of Biochemistry, Faculty of Science Masaryk University Kamenice 5 Brno 625 00 Czech Republic
| | - Tero Soukka
- Department of Life Technologies/Biotechnology University of Turku Kiinamyllynkatu 10 Turku 20520 Finland
| | - Hans H. Gorris
- Institute of Analytical Chemistry, Chemo‐ and Biosensors University of Regensburg Regensburg 93053 Germany
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Regan B, O'Kennedy R, Collins D. Advances in point-of-care testing for cardiovascular diseases. Adv Clin Chem 2021; 104:1-70. [PMID: 34462053 DOI: 10.1016/bs.acc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Point-of-care testing (POCT) is a specific format of diagnostic testing that is conducted without accompanying infrastructure or sophisticated instrumentation. Traditionally, such rapid sample-to-answer assays provide inferior analytical performances to their laboratory counterparts when measuring cardiac biomarkers. Hence, their potentially broad applicability is somewhat bound by their inability to detect clinically relevant concentrations of cardiac troponin (cTn) in the early stages of myocardial injury. However, the continuous refinement of biorecognition elements, the optimization of detection techniques, and the fabrication of tailored fluid handling systems to manage the sensing process has stimulated the production of commercial assays that can support accelerated diagnostic pathways. This review will present the latest commercial POC assays and examine their impact on clinical decision-making. The individual elements that constitute POC assays will be explored, with an emphasis on aspects that contribute to economically feasible and highly sensitive assays. Furthermore, the prospect of POCT imparting a greater influence on early interventions for medium to high-risk individuals and the potential to re-shape the paradigm of cardiovascular risk assessments will be discussed.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin, Ireland.
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin, Ireland
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