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Krintus M, Panteghini M. Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays. Clin Chem Lab Med 2021; 58:1773-1783. [PMID: 32134723 DOI: 10.1515/cclm-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians' role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 44 90, Fax: +48 52 585 36 03
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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2
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Reference limits of high-sensitive cardiac troponin T indirectly estimated by a new approach applying data mining. A special example for measurands with a relatively high percentage of values at or below the detection limit. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
A new model for the indirect estimation of reference limits (RLs) has been proposed recently and was coined TMC approach (truncated minimum chi-square estimation) which can be performed with R statistic. A spline function is applied to the RLs to get a continuous function if age is graphically presented vs. the RLs avoiding artificial “jumps” between different age groups. Most indirect models assume a power normal distribution and fail if this assumption is not fulfilled as e.g. if a relatively high percentage of measured values is below the detection limit and the data are distributed extremely skewed. This problem is handled by the TMC model. High-sensitive cardiac troponin T (hs cTnT) was chosen as an example. The hs cTnT concentration in serum or plasma is well accepted as a valuable marker in the diagnosis of acute myocardial infarction. Currently, the 99th percentile derived from a “healthy” subpopulation is the decision limit recommended by consensus groups. However, this decision limit is questioned by several authors for many reasons. In the present report, the 97.5th and the 99th percentile limits were reinvestigated by the TMC model with different subpopulations stratified according to age and sex and were finally compared to presently recommended decision limits. In summary, the generally recommended 99th percentile as a fixed decision limit should be reconsidered. It is suggested to apply more specific reference limits stratified for age and sex instead of a fixed decision limit.
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Acosta G, Amro A, Aguilar R, Abusnina W, Bhardwaj N, Koromia GA, Studeny M, Irfan A. Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis. Cureus 2020; 12:e6787. [PMID: 32140347 PMCID: PMC7045977 DOI: 10.7759/cureus.6787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/26/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93). Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
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Affiliation(s)
| | - Ahmed Amro
- Cardiology, Marshall University, Huntington, USA
| | - Rodrigo Aguilar
- Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Niharika Bhardwaj
- Clinical and Translational Science, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Mark Studeny
- Cardiology, Marshall University, Huntington, USA
| | - Affan Irfan
- Cardiology, Marshall University, Huntington, USA
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Rossi TM, Kavsak PA, Maxie MG, Pearl DL, Pyle WG, Physick-Sheard PW. Analytical validation of cardiac troponin I assays in horses. J Vet Diagn Invest 2017; 30:226-232. [PMID: 29224512 DOI: 10.1177/1040638717747070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human cardiac troponin I (cTnI) assays have been used in equine medicine, often without prior analytical validation for equine use. In the absence of appropriate validation, the clinical significance of assay results is uncertain and can lead to misdiagnosis. We followed the American Society for Veterinary Clinical Pathology guidelines and investigated linearity, precision, limit of quantification (LoQ), and comparative recovery for 6 commercial cTnI assays developed for use in human medicine. Clinically acceptable linearity was observed in assays A-D, whereas assay E did not detect equine cTnI in any sample. Comparative recovery revealed 1-3-fold differences between assay results, and low analyte recoveries (2.2-3.4%) were observed in assay F. Precision was investigated in assays A and B, and found to be within acceptable limits. The LoQ was 1.53 ng/L for assay A, and 0.031 µg/L for assay B. Assays A and B performed within clinically acceptable limits and were deemed suitable for use in equine medicine. Assays C and D did not undergo full validation but had acceptable linearity, which demonstrates their potential for use in equine medicine. Assays E and F are unsuitable for use in horses given issues with detection of equine cTnI. The variability in results between assays indicates that reference intervals and cutoffs for diagnostic decision-making are assay specific and should be established prior to adoption by diagnostic laboratories.
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Affiliation(s)
- Tanya M Rossi
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
| | - Peter A Kavsak
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
| | - M Grant Maxie
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
| | - David L Pearl
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
| | - W Glen Pyle
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
| | - Peter W Physick-Sheard
- Departments of Population Medicine (Rossi, Pearl, Physick-Sheard) and Biomedical Sciences (Pyle), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Ontario Veterinary College, Animal Health Laboratory (Maxie), Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (Kavsak)
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Abstract
Acute coronary syndrome (ACS) encompasses a pathophysiological spectrum of cardiovascular diseases, all of which have significant morbidity and mortality. ACS was once considered an acute condition; however, new treatment strategies and improvements in biomarker assays have led to ACS being an acute and chronic disease. Cardiac troponin is the preferred biomarker for the diagnosis of myocardial infarction, and there is considerable interest and efforts toward development and implementation of high-sensitivity cardiac troponin (hs-cTn) assays worldwide. Analytical and clinical performance characteristics of hs-cTn assays as well as testing limitations are important for laboratorians and clinicians to understand in order to utilize testing appropriately. Furthermore, expanding the clinical utility of hs-cTn into other cohorts such as asymptomatic community dwelling populations, heart failure, and chronic kidney disease populations supports novel opportunities for improved short- and long-term prognosis.
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Evidence-based approach to harmonised reference intervals. Clin Chim Acta 2014; 432:99-107. [DOI: 10.1016/j.cca.2013.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/01/2013] [Accepted: 10/20/2013] [Indexed: 11/24/2022]
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Rossi TM, Pyle WG, Maxie MG, Pearl DL, Physick-Sheard PW. Troponin assays in the assessment of the equine myocardium. Equine Vet J 2014; 46:270-5. [PMID: 24215569 DOI: 10.1111/evj.12209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/03/2013] [Indexed: 11/26/2022]
Abstract
In 2000, troponin assays were adopted as the test of choice for detection of myocardial injury in man. This decision was made after extensive testing and followed a 60 year search for a biomarker of myocardial damage with sufficient analytical sensitivity and specificity. This has led to proliferation of assays for use in human medicine, each requiring extensive testing and validation before it could be made available on the open market for human use. The search for ever-more analytically sensitive assays and for a standard reference material continues. The adoption of troponin testing in veterinary medicine followed shortly after its development for use in man, providing a much-needed means of detecting and monitoring myocardial damage in horses. However, application of these tests in veterinary medicine has exclusively involved use of assays designed for and clinically validated in human patients. There is no mandated requirement for test validation in veterinary medicine and, while many of these assays have been shown to be capable of detecting equine troponin, the wide diversity of available tests, lack of validation, absence of protocols for their use and lack of standardisation make their application problematic. The objective of this review article is to address this issue, offering guidance where data are available and encouraging caution where there are none. Ultimately, the overall goal of this review is to examine critically the use of troponin assays in the horse and to promote the accurate and appropriate interpretation of valid results.
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Affiliation(s)
- T M Rossi
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Ontario, Canada
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8
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Sandoval Y, Apple FS. The global need to define normality: the 99th percentile value of cardiac troponin. Clin Chem 2013; 60:455-62. [PMID: 24115136 DOI: 10.1373/clinchem.2013.211706] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND How to select a presumably normal population for the establishment of 99th percentile cutoffs for cardiac troponin assays has not been adequately addressed. Lack of attention to this question can result in misleading medical decision cutoffs. CONTENT From our review of the peer-reviewed literature, including international recommendations, no uniform procedure is followed and no uniform guideline has been published by experts or regulatory agencies to guide researchers or manufacturers of cardiac troponin assays in their quest to define the health or "normality" of a reference population that is used to establish an accurate 99th percentile value. As we progress globally into the era of high-sensitivity cardiac troponin assays, we propose several suggested approaches to define presumably normal individuals by use of clinical and biomarker surrogates. SUMMARY Our uniform approach to defining who is normal and who may not be normal will help to define diagnostic and risk outcomes assessments in the management of patients with suspected myocardial injury, both for use in current clinical practice and clinical research, as well as for the potential future use of cardiac troponin in primary prevention.
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Improved sensitivity of point of care troponin I values using reporting to below the 99th percentile of normals. Clin Biochem 2013; 46:979-982. [DOI: 10.1016/j.clinbiochem.2013.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 01/31/2023]
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10
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Keller T, Ojeda F, Zeller T, Wild PS, Tzikas S, Sinning CR, Peetz D, Münzel T, Blankenberg S, Lackner KJ. Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay. Int J Cardiol 2013; 167:1423-9. [DOI: 10.1016/j.ijcard.2012.04.063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/23/2012] [Accepted: 04/08/2012] [Indexed: 12/01/2022]
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11
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Cullen L, Parsonage WA, Greenslade J, Lamanna A, Hammett CJ, Than M, Tate J, Kalinowski L, Ungerer JPJ, Chu K, Brown A. Delta troponin for the early diagnosis of AMI in emergency patients with chest pain. Int J Cardiol 2013; 168:2602-8. [PMID: 23582689 DOI: 10.1016/j.ijcard.2013.03.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 11/26/2012] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES In patients presenting to the Emergency Department (ED) with potential acute myocardial infarction (AMI), elevated cardiac troponin (cTn) levels are indicative of myocardial necrosis. We assessed the accuracy of 'delta cTn' at 2h or 6h compared to the cTn concentration above the 99th percentile reference value for AMI in a prospective study of adult patients presenting to ED with symptoms suggestive of possible acute coronary syndrome. METHODS Blood was sampled for cardiac troponin I (cTnI) on presentation, and at 2h and 6h following presentation using a sensitive assay (Beckman AccuTnI). All clinical endpoints were adjudicated by a cardiologist who was blinded to the 2h cTn assay result. RESULTS Of the 874 patients, 70 (8%) were diagnosed with an AMI during their index presentation. The area under the ROC curve for diagnosing AMI at 2h was 0.89 [95%CI, 0.84-0.95] for absolute delta cTn versus 0.79 [95%CI 0.73-0.85] for the relative change. Specificity and PPV at 2h were optimized using a delta cTnI ≥ 0.03 μg/L (95.8% [95%CI 94.1-97.0] and 61.4% [95%CI 50.9-70.9] respectively). Sensitivity and NPV for AMI were optimized using the 99th percentile with the addition of a delta of<0.03 μg/L (97.1% [95%CI 90.2-99.2] and 99.7% [95%CI 99-99.9] respectively). CONCLUSIONS An algorithm incorporating cTnI concentration and delta cTn values with a sensitive troponin assay allows accurate diagnosis of AMI within 2h from presentation and earlier rule-out of AMI in the majority of patients.
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Affiliation(s)
- Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
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Thygesen K, Mair J, Giannitsis E, Mueller C, Lindahl B, Blankenberg S, Huber K, Plebani M, Biasucci LM, Tubaro M, Collinson P, Venge P, Hasin Y, Galvani M, Koenig W, Hamm C, Alpert JS, Katus H, Jaffe AS. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012; 33:2252-7. [PMID: 22723599 DOI: 10.1093/eurheartj/ehs154] [Citation(s) in RCA: 543] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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14
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Koerbin G, Tate JR, Hickman PE. Response to ‘Verification of assays, whose responsibility is it?’ by Fleming. Ann Clin Biochem 2011. [DOI: 10.1258/acb.2011.011003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Koerbin
- ACT Pathology, The Canberra Hospital, Canberra, ACT 2605
- Faculty of Applied Science, University of Canberra, Canberra, ACT 2605
| | - J R Tate
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland 4029
| | - P E Hickman
- ACT Pathology, The Canberra Hospital, Canberra, ACT 2605
- Medical School, Australian National University, Canberra, ACT 2605, Australia
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15
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Clinical performance of a new point-of-care cardiac troponin I assay compared to three laboratory troponin assays. Clin Chim Acta 2011; 412:370-5. [DOI: 10.1016/j.cca.2010.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 11/10/2010] [Accepted: 11/10/2010] [Indexed: 11/21/2022]
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16
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Vasatova M, Pudil R, Tichy M, Buchler T, Horacek JM, Haman L, Parizek P, Palicka V. High-sensitivity troponin T as a marker of myocardial injury after radiofrequency catheter ablation. Ann Clin Biochem 2010; 48:38-40. [DOI: 10.1258/acb.2010.009280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The aim of our study was to monitor radiofrequency catheter ablation-induced myocardial damage by measuring high-sensitivity cardiac troponin T (hs-cTnT). Methods Serum concentrations of hs-cTnT (Elecsys 2010 system, Roche) were measured in 73 healthy blood donors and serially in 27 patients who had samples taken both before and 24 h after radiofrequency ablation (RFA) for atrioventricular nodal re-entry tachycardia (AVNRT), atrial fibrillation (AF) or right atrial flutter (AFL). Results Significant increases of hs-cTnT were seen in patients after RFA (AVNRT: P = 0.0115, AF: P = 0.0011, AFL: P = 0.0009). Postprocedural serum hs-cTnT correlated with the number of radiofrequency applications and with the duration of RFA procedure. Spearman's coefficient of rank correlation ( r) were as follows: hs-cTnT versus RFA duration: r = 0.771 ( P < 0.001); hs-cTnT versus number of pulses: r = 0.708 ( P < 0.001). Patients with the diagnosis of AVNRT had lower serum hs-cTnT concentration after RFA compared with AFL ( P < 0.0001) and AF ( P < 0.0001) patients. Conclusions Our data indicate that RFA causes a significant increase of serum hs-cTnT concentration that could be used to monitor myocardial injury.
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Affiliation(s)
- M Vasatova
- Institute of Clinical Biochemistry and Diagnostics
| | - R Pudil
- 1st Department of Medicine, Charles University, Faculty of Medicine, University Hospital, Hradec Kralove
| | - M Tichy
- Institute of Clinical Biochemistry and Diagnostics
| | - T Buchler
- Department of Oncology and 1st Faculty of Medicine, Thomayer University Hospital, Charles University, Prague
| | - J M Horacek
- 2nd Department of Medicine – Clinical Hematology, Charles University, Faculty of Medicine, University Hospital, Hradec Kralove, Czech Republic
| | - L Haman
- 1st Department of Medicine, Charles University, Faculty of Medicine, University Hospital, Hradec Kralove
| | - P Parizek
- 1st Department of Medicine, Charles University, Faculty of Medicine, University Hospital, Hradec Kralove
| | - V Palicka
- Institute of Clinical Biochemistry and Diagnostics
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Tovey JA, Brain A, Penney MD. Calculation of the 99th percentile upper reference limit and clinical decision concentration of the Abbott STAT TnI assay. Ann Clin Biochem 2010; 47:576-7. [DOI: 10.1258/acb.2010.010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J A Tovey
- Department of Biochemistry, The Royal Gwent Hospital, Newport, South Wales, UK
| | - A Brain
- Department of Biochemistry, The Royal Gwent Hospital, Newport, South Wales, UK
| | - M D Penney
- Department of Biochemistry, The Royal Gwent Hospital, Newport, South Wales, UK
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Thygesen K, Mair J, Katus H, Plebani M, Venge P, Collinson P, Lindahl B, Giannitsis E, Hasin Y, Galvani M, Tubaro M, Alpert JS, Biasucci LM, Koenig W, Mueller C, Huber K, Hamm C, Jaffe AS. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010; 31:2197-204. [PMID: 20685679 DOI: 10.1093/eurheartj/ehq251] [Citation(s) in RCA: 427] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The release of cardiomyocyte components, i.e. biomarkers, into the bloodstream in higher than usual quantities indicates an ongoing pathological process. Thus, detection of elevated concentrations of cardiac biomarkers in blood is a sign of cardiac injury which could be due to supply-demand imbalance, toxic effects, or haemodynamic stress. It is up to the clinician to determine the most probable aetiology, the proper therapeutic measures, and the subsequent risk implied by the process. For this reason, the measurement of biomarkers always must be applied in relation to the clinical context and never in isolation. There are a large number of cardiac biomarkers, but they can be subdivided into four broad categories, those related to necrosis, inflammation, haemodynamic stress, and/or thrombosis. Their usefulness is dependent on the accuracy and reproducibility of the measurements, the discriminatory limits separating pathology from physiology, and their sensitivity and specificity for specific organ damage and/or disease processes. In recent years, cardiac biomarkers have become important adjuncts to the delivery of acute cardiac care. Therefore, the Working Group on Acute Cardiac Care of the European Society of Cardiology established a committee to deal with ongoing and newly developing issues related to cardiac biomarkers. The intention of the group is to outline the principles for the application of various biomarkers by clinicians in the setting of acute cardiac care in a series of expert consensus documents. The first of these will focus on cardiac troponin, a pivotal marker of cardiac injury/necrosis.
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Affiliation(s)
- Kristian Thygesen
- Department of Medicine and Cardiology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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Tate JR, Bunk DM, Christenson RH, Katrukha A, Noble JE, Porter RA, Schimmel H, Wang L, Panteghini M. Standardisation of cardiac troponin I measurement: past and present. Pathology 2010; 42:402-8. [DOI: 10.3109/00313025.2010.495246] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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La'ulu SL, Roberts WL. Performance characteristics of five cardiac Troponin I assays. Clin Chim Acta 2010; 411:1095-101. [DOI: 10.1016/j.cca.2010.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 11/27/2022]
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21
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Cardiac troponin T elevations, using highly sensitive assay, in recreational running depend on running distance. Clin Res Cardiol 2010; 99:385-91. [DOI: 10.1007/s00392-010-0134-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 02/15/2010] [Indexed: 01/09/2023]
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Aakre K, Landaas S, Hagve TA. Bruk av troponinmålinger i norske sykehus. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:278-81. [DOI: 10.4045/tidsskr.09.0286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fruchter O, Yigla M. Cardiac Troponin-I Predicts Long-Term Mortality in Chronic Obstructive Pulmonary Disease. COPD 2009; 6:155-61. [DOI: 10.1080/15412550902902620] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McDonnell B, Hearty S, Leonard P, O'Kennedy R. Cardiac biomarkers and the case for point-of-care testing. Clin Biochem 2009; 42:549-61. [DOI: 10.1016/j.clinbiochem.2009.01.019] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 01/23/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
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Panteghini M. Assay-related issues in the measurement of cardiac troponins. Clin Chim Acta 2009; 402:88-93. [PMID: 19168041 DOI: 10.1016/j.cca.2008.12.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 12/04/2008] [Accepted: 12/18/2008] [Indexed: 11/24/2022]
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Marwick TH, Branagan H, Venkatesh B, Stewart S. Use of a nurse-led intervention to optimize beta-blockade for reducing cardiac events after major noncardiac surgery. Am Heart J 2009; 157:784-90. [PMID: 19332211 DOI: 10.1016/j.ahj.2008.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although guidelines recommend the use of beta-adrenoceptor blocking drugs to reduce cardiac events (CEs) after major noncardiac surgery, trial results have varied between showing benefit, ineffectiveness, and harm. We sought whether optimizing beta-blockade (BB) delivery could make them more effective. METHODS Intermediate risk patients undergoing major noncardiac surgery (n = 400) were randomized to 2 strategies of BB therapy: universal BB (UBB; n = 197) comprising an algorithm-based, nurse-led strategy to optimize dosing and adherence to bisoprolol titration over > or =1 week preoperatively versus usual care (UC; n = 203), whereby BB are continued in those already taking them or prescribed for patients identified as high risk based on ischemia (new or inducible wall motion abnormalities) at dobutamine echocardiography (DbE). Daily electrocardiogram and troponin levels were obtained on 3 postoperative days. The primary end point was a major CE (cardiac death or myocardial infarction) within 30 days. RESULTS There were 25 major CEs (6.3%), occurring in 13 (6.6%) of 197 UBB and 12 (5.9%) of 203 UC patients (OR 1.12, 95% CI 0.52-2.39). Independent predictors of CEs were baseline systolic blood pressure (beta 1.02, P = .005) and postoperative hypotension (beta 1.02, P = .03) but not treatment strategy. Those randomized to UBB had significantly better heart rate control perioperatively, at the cost of bradycardia and hypotension. The negative predictive value of DbE in this study was 95%. CONCLUSIONS These data confirm a persistent CE rate after major noncardiac surgery despite nurse-led dose titration of bisoprolol. Cardiac events were equivalent to a UC strategy based on DbE results.
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Panteghini M. A critical appraisal of experimental factors influencing the definition of the 99th percentile limit for cardiac troponins. Clin Chem Lab Med 2009; 47:1179-82. [PMID: 19803807 DOI: 10.1515/cclm.2009.295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mauro Panteghini
- Department of Clinical Sciences, University of Milan Medical School, Milan, Italy.
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Affiliation(s)
- Julian H Barth
- Clinical Biochemistry and Immunology, Leeds General Infirmary, Leeds LS1 3EX, UK
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Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M. Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem 2008; 55:101-8. [PMID: 18988757 DOI: 10.1373/clinchem.2008.106427] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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 (<0.01 microg/L), only the hs-cTnT assay demonstrated a CV of <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 < 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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Affiliation(s)
- Alma Mingels
- Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands
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Song S, Suh B, Lee SG, Kim JH, Kwon OH. Comparison of 10% coefficient of variation and 99th percentile cutoff of troponin I in serum and heparinized plasma using Access 2 and DxI 800. Clin Chim Acta 2008; 399:117-8. [PMID: 18835262 DOI: 10.1016/j.cca.2008.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 09/09/2008] [Accepted: 09/10/2008] [Indexed: 11/17/2022]
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