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Krintus M, Panteghini M. Judging the clinical suitability of analytical performance of cardiac troponin assays. Clin Chem Lab Med 2023; 61:801-810. [PMID: 36798043 DOI: 10.1515/cclm-2023-0027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
New millennium diagnostic criteria for acute myocardial infarction precipitated a revolutionary shift from an approach based primarily on electrocardiography and clinical symptoms to a strategy based on biomarkers, and preferably cardiac troponins (cTn) I and T. In the last 20 years, clinical recommendations have strengthened the role of cTn and led to the development of highly sensitive (hs-cTn) assays, which are now leading players in all current clinical practice guidelines. To optimize the clinical use of these hs-cTn assays, focus on their analytical aspects has become increasingly important, emphasizing the need for the establishment of suitable analytical performance by the definition and implementation of appropriate specifications. An accurate estimate of measurement uncertainty, together with the acquisition of the highest analytical quality when very low concentrations of hs-cTn are measured, are essential requirements and should represent a practical laboratory standard in assuring optimal clinical use. Additional goals for further improving the quality of laboratory information should be the establishment of robust data concerning biological variation of cTn and the resolution of practical challenges opposed to the harmonization of cTn I results obtained by differing commercial measuring systems.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Torun, Poland
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
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2
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Kavsak PA, Nouri K. Low-risk cutoff of 90 ml/min/1.73 m 2 for the estimated glomerular filtration rate and the importance of the equation for patients with acute coronary syndrome. Clin Chim Acta 2021; 523:532-533. [PMID: 34767793 DOI: 10.1016/j.cca.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
| | - Kazem Nouri
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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3
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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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Bellia C, Lombardo M, Della-Morte D. Use of Troponin as a predictor for cardiovascular diseases in patients with type 2 Diabetes Mellitus. Clin Chim Acta 2020; 507:54-61. [PMID: 32302683 DOI: 10.1016/j.cca.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
People with type 2 diabetes mellitus (T2DM) have two- to four-fold increased cardiovascular mortality in comparison to the general population. With the identification of new therapeutic targets and hypoglycemic drugs for T2DM, the need for a better stratification of CVD risk has emerged to select patients who may need intensive or specific treatment. At present, risk stratification is based on clinical, demographic, and biochemical factors. High sensitivity cardiac troponin (hs-cTn) increases after several ischemic and non-ischemic insults and it is considered a marker of myocardial injury. This review summarizes the main findings about hs-cTn utilization for risk stratification in people with T2DM and no clinical CVD. Several large observational studies have documented the association between hs-cTn and adverse cardiovascular outcomes in both the general population and in patients with T2DM. Lifestyle interventions, and particularly promotion of physical activity and adoption of healthy nutritional habits, have been associated to a significant benefit on hs-cTn release in the general population. Randomized controlled trials suggested that hypoglycemic, anti-hypertensive and lipid-lowering therapy may influence the degree of T2DM-induced cardiac injury. Besides these promising findings, the efficacy of an hs-cTn-based approach for CVD prevention in T2DM patients still requires more investigations.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Italy.
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Fitzgerald RL, Hollander JE, Peacock WF, Limkakeng AT, Breitenbeck N, Rivers EJ, Ziegler A, Laimighofer M, deFilippi C. The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States. Clin Chim Acta 2020; 504:172-179. [PMID: 32001233 DOI: 10.1016/j.cca.2020.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Determining diagnostic thresholds for cardiac troponin assays is key to interpreting their clinical performance. We describe the calculation of 99th percentile upper reference limits (URLs) for the Elecsys® Troponin T Gen 5 (TnT Gen 5) assay. METHODS Plasma and serum samples from healthy US participants were prospectively evaluated using TnT Gen 5 Short Turn Around Time and 18-min assays on cobas e 411 and cobas e 601 analyzers (Roche Diagnostics); with, up to 8 TnT Gen 5 results per participant. RESULTS A total of 10,402 TnT Gen 5 results from 1301 participants were included (50.4% female). Across 9 calculation methods, overall 99th percentile URL was 19.2 ng/l (females, 13.5-13.6 ng/l; males, 21.4-22.2 ng/l). Across different sample/assay/analyzer combinations, overall 99th percentile URLs ranged from 18.4-20.2 ng/l. Median TnT Gen 5 results increased with age, were higher in males, and ranged from 3.0-3.7 ng/l across races/ethnicities and from 3.0-3.6 ng/l across body mass index (BMI) classes. Applying additional exclusion criteria (N-terminal pro-brain natriuretic peptide, BMI and estimated glomerular filtration rate) resulted in lower 99th percentile URLs (overall, 16.9 ng/l; females, 11.8 ng/l; males, 18.5 ng/l). CONCLUSION Our findings facilitate the interpretation of TnT Gen 5 results in US clinical practice.
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Affiliation(s)
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | - E Joy Rivers
- Agent Representing Roche Professional Diagnostics, Indianapolis, IN, USA
| | - André Ziegler
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
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Pasqualetti S, Panteghini M. Highly sensitive troponin T measurement after pneumatic tube transportation: The sample type can make the difference. Clin Chim Acta 2019; 503:231-232. [PMID: 31678578 DOI: 10.1016/j.cca.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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7
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Braga F, Aloisio E, Panzeri A, Nakagawa T, Panteghini M. Analytical validation of a highly sensitive point-of-care system for cardiac troponin I determination. ACTA ACUST UNITED AC 2019; 58:138-145. [DOI: 10.1515/cclm-2019-0801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/22/2019] [Indexed: 12/28/2022]
Abstract
Abstract
Background
Highly sensitive cardiac troponin assays (hs-cTn) are not available as point-of-care (POC) measurements. As rapid testing cannot be achieved at the expense of clinical performance, there is an urgent need to develop and rigorously validate POC hs-cTn. Konica Minolta (KM) has recently developed a surface plasmon-field enhanced fluorescence spectroscopy-based POC hs-cTn I system.
Methods
We validated the analytical characteristics of the KM POC system according to the international guidelines.
Results
Limit of blank (LoB) and limit of detection (LoD) were 0.35 and 0.62 ng/L, respectively, hs-cTn I concentrations corresponding to a total CV of 20%, 10% and 5% were 1.5, 3.9 and 11.0 ng/L, respectively. Method comparison studies showed that KM calibration was successfully traced to higher-order references. Limit of quantitation (LoQ), i.e. the hs-cTn I concentration having a total error of measurement of ≤34%, was 10.0 ng/L. The upper reference limit (URL) for 600 healthy blood donors was calculated at 12.2 ng/L (90% confidence interval [CI]: 9.2–39.2), while sex-partitioned URLs were 20.6 (males) and 10.7 ng/L (females), respectively (p < 0.0001). KM assay measured hs-cTn I concentrations >LoD in 65.7% of all reference individuals, in 76.7% of males and in 54.7% of females, respectively.
Conclusions
The KM system joins the characteristics of POC systems to the analytical performance of hs-cTn.
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Affiliation(s)
- Federica Braga
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Via GB Grassi 74 , 20157 Milano , Italy , Phone: +390239042743, Fax: +390250319835
| | - Elena Aloisio
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
| | - Andrea Panzeri
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
| | - Takahito Nakagawa
- Konica Minolta, Inc., Project Promotion Department , Product Planning Division, Precision Medicine Business Unit , Tokyo , Japan
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
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8
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Aloisio E, Pasqualetti S, Dolci A, Panteghini M. Daily monitoring of a control material with a concentration near the limit of detection improves the measurement accuracy of highly sensitive troponin assays. ACTA ACUST UNITED AC 2019; 58:e29-e31. [DOI: 10.1515/cclm-2019-0702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/05/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Elena Aloisio
- Clinical Pathology Unit , ASST Fatebenefratelli-Sacco , Via GB Grassi 74 , 20157 Milan , Italy , Phone: +39 02 39042683, Fax: +39 02 39042896
| | - Sara Pasqualetti
- Clinical Pathology Unit , ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Alberto Dolci
- Clinical Pathology Unit , ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Mauro Panteghini
- Clinical Pathology Unit , ASST Fatebenefratelli-Sacco , Milan , Italy
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9
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Kavsak PA. Should detectable cardiac troponin concentrations in a healthy population be the only criterion for classifying high-sensitivity cardiac troponin assays? Clin Biochem 2018; 56:1-3. [DOI: 10.1016/j.clinbiochem.2018.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
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Kavsak PA, Andruchow JE, McRae AD, Worster A. Profile of Roche’s Elecsys Troponin T Gen 5 STAT blood test (a high-sensitivity cardiac troponin assay) for diagnosing myocardial infarction in the emergency department. Expert Rev Mol Diagn 2018; 18:481-489. [DOI: 10.1080/14737159.2018.1476141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James E. Andruchow
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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