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Salaun E, Drory S, Coté MA, Tremblay V, Bédard E, Steinberg C, Paré D, O'Connor K, Cieza T, Coté N, Poirier P, Douville P, Blais J, Desmeules P, Kalavrouziotis D, Mohammadi S, Voisine P, Bernier M, Pibarot P, Thériault S. Role of Antitroponin Antibodies and Macrotroponin in the Clinical Interpretation of Cardiac Troponin. J Am Heart Assoc 2024; 13:e035128. [PMID: 38879450 DOI: 10.1161/jaha.123.035128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Abstract
Cardiac troponin is extensively used as a biomarker in modern medicine due to its diagnostic capability for myocardial injury, as well as its predictive and prognostic value for cardiac diseases. However, heterophile antibodies, antitroponin antibodies, and macrotroponin complexes can be observed both in seemingly healthy individuals and patients with cardiac diseases, potentially leading to false positive or disproportionate elevation of cTn (cardiac troponin) assay results and introducing discrepancies in clinical interpretations with impact on medical management. In this review article, we describe the possible mechanisms of cTn release and the sources of variations in the assessment of circulating cTn levels. We also explore the pathophysiological mechanisms underlying antitroponin antibody development and discuss the influence exerted by macrotroponin complexes on the results of immunoassays. Additionally, we explore approaches to detect these complexes by presenting various clinical scenarios encountered in routine clinical practice. Finally, unsolved questions about the development, prevalence, and clinical significance of cardiac autoantibodies are discussed.
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Affiliation(s)
- Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Samuel Drory
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Marc-André Coté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Veronic Tremblay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Elisabeth Bédard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - David Paré
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Tomas Cieza
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Nancy Coté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
- Faculty of pharmacy Université Laval Québec Canada
| | - Pierre Douville
- Centre Hospitalier Universitaire de Québec Université Laval Québec Canada
| | - Jonatan Blais
- Centre Hospitalier Universitaire de Québec Université Laval Québec Canada
| | - Philippe Desmeules
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
- Centre Hospitalier Universitaire de Québec Université Laval Québec Canada
| | - Dimitris Kalavrouziotis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Siamak Mohammadi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
| | - Sébastien Thériault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Université Laval Québec Canada
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2
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Green AD, Lee GR. An appraisal of the practice of duplicate testing for the detection of irregular analytical errors. Clin Chem Lab Med 2024; 62:627-634. [PMID: 37942778 DOI: 10.1515/cclm-2022-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Our study aimed to determine the usefulness of duplicate testing in identifying irregular analytical errors and subsequent prevention of patient mismanagement. METHODS In our laboratory, all requests for Na+, Ca2+, alkaline phosphatase (ALP), and high-sensitivity cardiac-troponin-I (hs-cTnI) are run in duplicate. Data from four separate weeks for Na+ (n=21,649), Ca2+ (n=14,803) and ALP (n=19,698); and a full year for hs-cTnI (n=17,036) were gathered. For each test, pre-defined limits for differences between duplicates were used to identify erroneous results (Fliers). We further characterised a subset of such fliers as "critical errors", where duplicates fell on opposing sides of a reference/decision making threshold. The costs/benefits of running these tests in duplicate were then considered in light of increased number of tests analysed by this approach. RESULTS For Na+, 0.03 % of duplicates met our flier defining criteria, and 0.01 % of specimens were considered critical errors. For Ca2+ requests, 4.58 % of results met our flier defining criteria and 0.84 % were critical errors. For ALP, 0.22 % of results were fliers, and 0.01 % were critical errors. For hs-cTnI, 1.58 % of results were classified as fliers, whilst 0.14 % were classified as a critical error. Depending on the test in question, running all analyses in duplicate increased annual costs by as little as €1,100 (for sodium), and as much as €48,000 (for hs-cTnI). CONCLUSIONS Duplicate testing is effective at identifying and mitigating irregular laboratory errors, and is best suited for assays predisposed to such error, where costs are minimal, and clinical significance of an incorrect result can justify the practice.
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Affiliation(s)
- Alastair D Green
- Department of Clinical Biochemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Graham R Lee
- Department of Clinical Biochemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
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Malaeb H, Vera MA, Sangal RB, Venkatesh AK, Possick S, Maciejak L, Oberle E, El-Khoury JM. Rapid serum tubes reduce transport hemolysis and false positive rates for high-sensitivity troponin T. Clin Chim Acta 2023; 551:117630. [PMID: 38420909 DOI: 10.1016/j.cca.2023.117630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Hemolysis in the emergency department (ED) can significantly delay results and appropriate action. We evaluated the main sources of hemolysis during sample collection, and to evaluate the use of rapid serum tubes (RST) as a transport hemolysis-mitigating measure for high-sensitivity troponin T (hs-cTnT) testing. METHODS We examined the effect of tube type, tube fill, types of sample draw and collection methods on hemolysis and hs-cTnT in samples (n = 158) from ED patients. We also compared hs-cTnT values in paired RST and plasma separate tube (PST) samples that were hemolysis-free. RESULTS The primary source of hemolysis in samples collected in the ED was underfilling tubes. In both tube types, PST and RST, filled tubes showed a median reduction in hemolysis of 69.1 % (p < 0.0001). Blood collected in RST also experienced less hemolysis compared to PST. In hemolysis-free samples, false positive results in PST were noted in patients with hs-cTnT values < 50 ng/l. CONCLUSION We suggest that proper tube filling during sample collection and use of RST tubes can significantly reduce the effects of hemolysis. In addition, laboratories should be aware that PST tubes have a non-trivial rate of false positives when hs-cTnT < 50 ng/l.
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Affiliation(s)
- Hind Malaeb
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Michael A Vera
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rohit B Sangal
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Arjun K Venkatesh
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Stephen Possick
- Departments of Cardiology, Yale School of Medicine, New Haven, CT, United States
| | - Lisa Maciejak
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Erica Oberle
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Joe M El-Khoury
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States.
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Bosi D, Canovi S, Pennacchioni A, Demola P, Corradini M, Guiducci V, Colla R, Navazio A. "Troponinosis", the Cardiologist's Curse-When Clinic-Laboratory Interaction Unveils the Mystery: A Case Report. J Cardiovasc Dev Dis 2023; 10:378. [PMID: 37754807 PMCID: PMC10531523 DOI: 10.3390/jcdd10090378] [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: 08/07/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Cardiac troponins are key diagnostic and prognostic biomarkers in acute myocardial infarction and, more generally, for the detection of myocardial injury. Since the introduction of the first immunochemistry methods, there has been a remarkable evolution in analytical performance, especially concerning a progressive improvement in sensitivity. However, the measurement of circulating troponins remains rarely susceptible to analytical interferences. We report a case of persistently elevated troponin I concentrations in a patient with known ischemic heart disease, which almost led to unnecessary diagnostic-therapeutic interventions. A prompt laboratory consultation by the cardiologist ultimately led to the identification of an analytical interference due to troponin macrocomplexes (macrotroponin) causing elevated troponin values in the absence of a clinical presentation compatible with myocardial damage.
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Affiliation(s)
- Davide Bosi
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Simone Canovi
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Andrea Pennacchioni
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Pierluigi Demola
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Mattia Corradini
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Vincenzo Guiducci
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Rossana Colla
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Alessandro Navazio
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
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Hammarsten O, Warner JV, Lam L, Kavsak P, Lindahl B, Aakre KM, Collinson P, Jaffe AS, Saenger AK, Body R, Mills NL, Omland T, Ordonez-Llanos J, Apple FS. Antibody-mediated interferences affecting cardiac troponin assays: recommendations from the IFCC Committee on Clinical Applications of Cardiac Biomarkers. Clin Chem Lab Med 2023; 61:1411-1419. [PMID: 36952681 DOI: 10.1515/cclm-2023-0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 03/25/2023]
Abstract
The International Federation of Clinical Chemistry Committee on Clinical Applications of Cardiac Biomarkers (IFCC C-CB) provides educational documents to facilitate the interpretation and use of cardiac biomarkers in clinical laboratories and practice. Our aim is to improve the understanding of certain key analytical and clinical aspects of cardiac biomarkers and how these may interplay. Measurements of cardiac troponin (cTn) have a prominent place in the clinical work-up of patients with suspected acute coronary syndrome. It is therefore important that clinical laboratories know how to recognize and assess analytical issues. Two emerging analytical issues resulting in falsely high cTn concentrations, often several fold higher than the upper reference limit (URL), are antibody-mediated assay interference due to long-lived cTn-antibody complexes, called macrotroponin, and crosslinking antibodies that are frequently referred to as heterophilic antibodies. We provide an overview of antibody-mediated cTn assay interference and provide recommendations on how to confirm the interference and interpret the results.
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Affiliation(s)
- Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Janet V Warner
- Faculty of Medicine, The University of Queensland, Saint Lucia, Australia
| | - Leo Lam
- Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Biochemistry, Middlemore Hospital Laboratories, Auckland, New Zealand
| | - Peter Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Paul Collinson
- Departments of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Allan S Jaffe
- Departments of Laboratory Medicine and Pathology and Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Amy K Saenger
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, MN, USA
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Healthcare Sciences Department, Manchester Metropolitan University, Manchester, UK
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jordi Ordonez-Llanos
- Servicio de Bioquímica Clínica, Hospital de Sant Pau, Barcelona, Spain
- Foundation for the Biochemistry and Molecular Pathology, Barcelona, Spain
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, MN, USA
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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6
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Big Data in Gastroenterology Research. Int J Mol Sci 2023; 24:ijms24032458. [PMID: 36768780 PMCID: PMC9916510 DOI: 10.3390/ijms24032458] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Studying individual data types in isolation provides only limited and incomplete answers to complex biological questions and particularly falls short in revealing sufficient mechanistic and kinetic details. In contrast, multi-omics approaches to studying health and disease permit the generation and integration of multiple data types on a much larger scale, offering a comprehensive picture of biological and disease processes. Gastroenterology and hepatobiliary research are particularly well-suited to such analyses, given the unique position of the luminal gastrointestinal (GI) tract at the nexus between the gut (mucosa and luminal contents), brain, immune and endocrine systems, and GI microbiome. The generation of 'big data' from multi-omic, multi-site studies can enhance investigations into the connections between these organ systems and organisms and more broadly and accurately appraise the effects of dietary, pharmacological, and other therapeutic interventions. In this review, we describe a variety of useful omics approaches and how they can be integrated to provide a holistic depiction of the human and microbial genetic and proteomic changes underlying physiological and pathophysiological phenomena. We highlight the potential pitfalls and alternatives to help avoid the common errors in study design, execution, and analysis. We focus on the application, integration, and analysis of big data in gastroenterology and hepatobiliary research.
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7
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Inflammageing and Cardiovascular System: Focus on Cardiokines and Cardiac-Specific Biomarkers. Int J Mol Sci 2023; 24:ijms24010844. [PMID: 36614282 PMCID: PMC9820990 DOI: 10.3390/ijms24010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
The term "inflammageing" was introduced in 2000, with the aim of describing the chronic inflammatory state typical of elderly individuals, which is characterized by a combination of elevated levels of inflammatory biomarkers, a high burden of comorbidities, an elevated risk of disability, frailty, and premature death. Inflammageing is a hallmark of various cardiovascular diseases, including atherosclerosis, hypertension, and rapid progression to heart failure. The great experimental and clinical evidence accumulated in recent years has clearly demonstrated that early detection and counteraction of inflammageing is a promising strategy not only to prevent cardiovascular disease, but also to slow down the progressive decline of health that occurs with ageing. It is conceivable that beneficial effects of counteracting inflammageing should be most effective if implemented in the early stages, when the compensatory capacity of the organism is not completely exhausted. Early interventions and treatments require early diagnosis using reliable and cost-effective biomarkers. Indeed, recent clinical studies have demonstrated that cardiac-specific biomarkers (i.e., cardiac natriuretic peptides and cardiac troponins) are able to identify, even in the general population, the individuals at highest risk of progression to heart failure. However, further clinical studies are needed to better understand the usefulness and cost/benefit ratio of cardiac-specific biomarkers as potential targets in preventive and therapeutic strategies for early detection and counteraction of inflammageing mechanisms and in this way slowing the progressive decline of health that occurs with ageing.
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Sharma NR, Sharma B, Pokhrel M, Gautam S, Lamichhane S. The Dilemma Behind Negative Troponin: A Case Report. Cureus 2023; 15:e34377. [PMID: 36874680 PMCID: PMC9976509 DOI: 10.7759/cureus.34377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
Acute coronary syndrome remains the primary cause of mortality and morbidity in the United States. Cardiac ischemia is a consequence of an imbalance between oxygen demand and supply. The sensitivity of troponin is above 99% in diagnosing cardiac injury; rare exceptions can occur, however. We present a case of acute coronary syndrome with a negative troponin level, even on repeated testing using different methods at two different centers.
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Affiliation(s)
- Nava R Sharma
- Medicine, Manipal College of Medical Science, Pokhara, NPL
| | - Bharosa Sharma
- Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | | | | | - Saral Lamichhane
- Department of Internal Medicine, Gandaki Medical College, Pokhara, NPL
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9
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Engler RJM, Montgomery JR, Spooner CE, Nelson MR, Collins LC, Ryan MA, Chu CS, Atwood JE, Hulten EA, Rutt AA, Parish DO, McClenathan BM, Hrncir DE, Duran L, Skerrett C, Housel LA, Brunader JA, Ryder SL, Lohsl CL, Hemann BA, Cooper LT. Myocarditis and pericarditis recovery following smallpox vaccine 2002-2016: A comparative observational cohort study in the military health system. PLoS One 2023; 18:e0283988. [PMID: 37155666 PMCID: PMC10166549 DOI: 10.1371/journal.pone.0283988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/21/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES (1) Characterize the initial clinical characteristics and long-term outcomes of smallpox vaccine-associated hypersensitivity myocarditis and pericarditis (MP) in United States service members. (2) Describe the process of case identification and adjudication using the 2003 CDC nationally defined myocarditis/pericarditis epidemiologic case definitions to include consideration of case-specific diversity and evolving evidence. BACKGROUND Between 2002 and 2016, 2.546 million service members received a smallpox Vaccinia vaccine. Acute MP is associated with vaccinia, but the long-term outcomes have not been studied. METHODS Records of vaccinia-associated MP reported to the Vaccine Adverse Event Reporting System by vaccination date were adjudicated using the 2003 MP epidemiologic case definitions for inclusion in a retrospective observational cohort study. Descriptive statistics of clinical characteristics, presentation, cardiac complications, and time course of clinical and cardiac recovery were calculated with comparisons by gender, diagnosis and time to recovery. RESULTS Out of over 5000 adverse event reports, 348 MP cases who survived the acute illness, including 276 myocarditis (99.6% probable/confirmed) and 72 pericarditis (29.2% probable/confirmed), were adjudicated for inclusion in the long-term follow-up. Demographics included a median age of 24 years (IQR 21,30) and male predominance (96%). Compared to background military population, the myocarditis and pericarditis cohort had a higher percentage of white males by 8.2% (95% CI: 5.6, 10.0) and age <40 years by 4.2% (95% CI: 1.7,5.8). Long-term follow-up documented full recovery in 267/306 (87.3%) with 74.9% recovered in less than a year (median ~3 months). Among patients with myocarditis, the percentage who had a delayed time to recovery at time of last follow-up was 12.8% (95% CI: 2.1,24.7) higher in those with an acute left ventricular ejection fraction (EF) of ≤50% and 13.5% (95% CI: 2.4,25.7) higher in those with hypokinesis. Patient complications included 6 ventricular arrhythmias (2 received implanted defibrillators) and 14 with atrial arrhythmias (2 received radiofrequency ablation). Three of 6 patients (50%) diagnosed with cardiomyopathy had clinical recovery at their last follow-up date. CONCLUSIONS Hypersensitivity myocarditis/pericarditis following the smallpox vaccine is associated with full clinical and functional ventricular recovery in over 87% of cases (74.9% <1 year). A minority of MP cases experienced prolonged or incomplete recovery beyond 1 year.
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Affiliation(s)
- Renata J M Engler
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- MDC Global Solutions, LLC, Manassas, Virginia, United States of America
| | - Jay R Montgomery
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Christina E Spooner
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Michael R Nelson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Limone C Collins
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Margaret A Ryan
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Naval Medical Center, San Diego, California, United States of America
| | - Clara S Chu
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- MDC Global Solutions, LLC, Manassas, Virginia, United States of America
| | - John E Atwood
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Edward A Hulten
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Ahlea A Rutt
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- MDC Global Solutions, LLC, Manassas, Virginia, United States of America
| | - Dacia O Parish
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Bruce M McClenathan
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Womack Army Medical Center, Fort Bragg, North Carolina, United States of America
| | - David E Hrncir
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Texas, United States of America
| | - Laurie Duran
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Catherine Skerrett
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Texas, United States of America
| | - Laurie A Housel
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Womack Army Medical Center, Fort Bragg, North Carolina, United States of America
| | - Janet A Brunader
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Stephanie L Ryder
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Connie L Lohsl
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Brian A Hemann
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Cardiocare, LLC, Chevy Chase, Maryland, United States of America
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
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10
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Lackner KJ. Cardiac troponins - a paradigm for diagnostic biomarker identification and development. Clin Chem Lab Med 2022; 61:795-800. [PMID: 36377312 DOI: 10.1515/cclm-2022-1112] [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: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022]
Abstract
The introduction of cardiac troponins into clinical diagnostics has not only improved diagnostic pathways for myocardial infarction but also profoundly influenced the definition of myocardial infarction. The term troponin appeared in the literature almost 60 years ago, i.e. shortly after this journal was founded. The development of cardiac troponins from proteins involved in muscle contraction, which were in the focus of few specialized research groups from physiology and biochemistry, to one of the most frequently measured protein biomarkers in medicine is a paradigmatic success story which is also reflected in almost 300 publications on the topic in this journal. From the viewpoint of biomarker development the critical success factors were medical need, timely generation of medical evidence, and the rapid development of robust and precise laboratory assays.
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Affiliation(s)
- Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz Mainz, Germany
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11
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Paul HA, Chi Q, Gifford JL, Seiden-Long I. Not T too! False elevations in high-sensitivity cardiac troponin T (hs-TnT) following specimen transport. Clin Biochem 2022; 115:86-91. [PMID: 36027942 DOI: 10.1016/j.clinbiochem.2022.08.008] [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: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Though false elevations attributed to preanalytical specimen handling have been widely reported for Troponin I (TnI), Troponin T (TnT) has appeared more robust to falsely elevated Tn. We describe reproducible false elevations in high sensitivity TnT (hs-TnT) in specimens after courier transport in plasma separator tubes (PST) off-site for testing. Hs-TnT was measured under 5 different conditions: 1) at collection location (N=24); 2) after transport upright in racks (N=66); 3) after transport with no control over tube agitation (N=69); 4) on transported aliquots (N=84); or 5) immediately after transport with no control over tube agitation (N=16), followed by keeping the specimen upright and re-measuring at 1hr, 2hr, 4hr, and 20-24hrs (N=6). To assess the degree of discrepancy, plasma from the original PST was aliquotted, re-centrifuged, potential debris removed, and hs-TnT re-measured. 43% of PST specimens collected offsite and transported with no control over tube agitation had clinically significant false elevations of hs-TnT which subsequently decreased following aliquotting and re-centrifugation (median decrease =9.9ng/L). Onsite testing or transported aliquots demonstrated no discrepancy. After being kept upright, discrepant specimens were not different from re-centrifuged aliquots by 4hrs (p=0.6141, repeated measures ANOVA with Dunn's multiple comparisons). Clinically significant false elevations of hs-TnT occurred in approximately 40% of separated PSTs that were transported in containers where specimens are transported with no control over tube agitation. This interference does not occur if plasma is aliquoted or if hs-TnT is tested at the collection site. In order to prevent these false elevations, and their potential patient impact on the diagnosis of acute myocardial infarction, specimens for hs-TnT measurement should be aliquoted at the collection location prior to transport.
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Affiliation(s)
- Heather A Paul
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Qingli Chi
- Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Jessica L Gifford
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isolde Seiden-Long
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Correspoooonding author at: Foothills Medical Centre, McCaig Tower, Rm 7507, 7(th) Floor, 3134 Hospital Drive NW, Canada.
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12
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Soluble Isoform of Suppression of Tumorigenicity 2 (ST2) Biomarker in a Large Cohort of Healthy Pediatric Population: Determination of Reference Intervals. J Clin Med 2022; 11:jcm11164693. [PMID: 36012931 PMCID: PMC9409801 DOI: 10.3390/jcm11164693] [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: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction: Only little data exists on ST2 reference intervals in healthy pediatric populations despite the high importance of this biomarker in adults with heart failure. The aim of the study was to assess the reference intervals of ST2 in a wide healthy pediatric cohort. Methods: We evaluated the serum concentrations of ST2 biomarker in 415 healthy pediatric subjects referred to our analysis laboratory. Subjects were categorized according to age (i.e., 0−6 (n = 79), 7−11 (n = 142) and 12−18 years (n = 191)) and sex. They were not suffering from any cardiac disorders, metabolic disorders, lung diseases, autoimmune disorders or malignancies. A written consent was obtained for each individual. No duplicate patients were included in the analysis and the presence of outliers was investigated. Reference intervals (Mean and central 95% confidence intervals) were determined. Results: Three outliers have been identified and removed from the analysis (60.0, 64.0 and 150.2 ng/mL). A total of 412 subjects were therefore included. The mean value for the whole population was 15.8 ng/mL (2.4−36.4 ng/mL). Males present a significantly higher mean concentration compared to females (17.2 versus 14.4 ng/mL, p = 0.001). A significant trend toward higher ST2 values with age was also observed, but for males only (r = 0.43, p < 0.0001). If considering age partitions, only males of 12−18 years (mean = 21.7 ng/mL) had significantly higher ST2 values compared to the other groups (ranging from 11.9 for males 0−6 years to 15.2 for females 12−18 years; p < 0.0001). Conclusions: We described age and sex-specific reference intervals for ST2 in a large healthy pediatric population. We found that ST2 values differ between sexes if considering all participants. A significant increase in ST2 with age was also observed, but only for males of 12−18 years.
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13
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Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158977. [PMID: 35897347 PMCID: PMC9331944 DOI: 10.3390/ijerph19158977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
Dual antiplatelet therapy (DAPT) has remained the cornerstone for management of acute coronary syndrome (ACS) over the years. Clopidogrel has been the quintessential P2Y12 receptor (platelet receptor for Adenosine 5′ diphosphate) inhibitor for the past two decades. With the demonstration of unequivocal superior efficacy of prasugrel/ticagrelor over clopidogrel, guidelines now recommend these agents in priority over clopidogrel in current management of ACS. Cangrelor has revived the interest in injectable antiplatelet therapy too. Albeit the increased efficacy of these newer agents comes at the cost of increased bleeding and this becomes more of a concern when combined with aspirin. Which P2Y12i is superior over another has been intensely debated over last few years after the ISAR-REACT 5 study with inconclusive data. Three novel antiplatelet agents are already in the pipeline for ACS with all of them succeeding in phase II studies. The search for an ideal antiplatelet remains a need of the hour for optimal reduction of ischemic events in ACS.
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14
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Favresse J, Schiettecatte J, Wolff F, Cotton F, Elsen M, Eucher C, Rosseels C, Anckaert E. Two-site evaluation of the Roche Elecsys Vitamin D total III assay. Clin Chem Lab Med 2022; 60:1598-1606. [DOI: 10.1515/cclm-2022-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The high request for vitamin D testing in the last decades has led manufacturers to develop assays on automated immunoassay platforms. The objective of this study was to evaluate the performance of the new Elecsys Vitamin D total III assay for the measurement of total 25(OH)D.
Methods
A total of 844 serum samples collected in two clinical laboratories were used to evaluate the new Roche Elecsys Vitamin D total III assay. Comparisons with Roche Elecsys Vitamin D total II and liquid chromatography tandem mass spectrometry (LC-MS/MS) were carried out. Additionally, assay imprecision, linearity, matrix effects, biotin interference, cross-reactivity with 24,25(OH)2D3 and 3-epi-25(OH)D3, and outlier rate were evaluated for the Elecsys Vitamin D total III assay.
Results
Only the comparison between LC-MS/MS and Roche Elecsys Vitamin D total III achieved the optimal specification for bias (i.e., <3.4%). Imprecision, linearity and matrix effects showed acceptable results. The biotin interference threshold was increased up to 1,200 ng/mL and the outlier rate was low (0.26%). The cross-reactivity with 24,25(OH)2D3 and 3-epi-25(OH)D3 was weak or modest in available patient samples. However, using SRM972a with a high level of 3-epi-25(OH)D3 (enriched) revealed an important cross-reactivity with both Roche Elecsys Vitamin D total II and III assays (+74.7% and +73.7%).
Conclusions
In conclusion, the Roche Elecsys Vitamin D total III assay presents several advantages compared to the previous assay generation: higher biotin interference threshold, broader measuring range, and better comparability with LC-MS/MS. However, the cross-reactivity toward 3-epi-25(OH)D3 is still problematic in high titer samples.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
- Department of Pharmacy , Namur Research Institute for Life Sciences, University of Namur , Namur , Belgium
| | - Johan Schiettecatte
- Department of Clinical Chemistry and Radioimmunology , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel) , Brussels , Belgium
| | - Fleur Wolff
- Department of Clinical Chemistry , LHUB-ULB, Université Libre de Bruxelles , Brussels , Belgium
| | - Frederic Cotton
- Department of Clinical Chemistry , LHUB-ULB, Université Libre de Bruxelles , Brussels , Belgium
| | - Marc Elsen
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Christine Eucher
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Catherine Rosseels
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Ellen Anckaert
- Department of Clinical Chemistry and Radioimmunology , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel) , Brussels , Belgium
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15
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Di Renzo L, Marchetti M, Rizzo G, Gualtieri P, Monsignore D, Dominici F, Mappa I, Cavicchioni O, Aguzzoli L, De Lorenzo A. Adherence to Mediterranean Diet and Its Association with Maternal and Newborn Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148497. [PMID: 35886346 PMCID: PMC9321919 DOI: 10.3390/ijerph19148497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
Background: Pregnancy is a crucial stage in a woman’s life and can be affected by epigenetic and environmental factors. Diet also plays a key role in gestation. This study aimed to evaluate how a greater or lesser adherence to the Mediterranean Diet (MD) influences specific parameters of mother and newborn. Methods: After delivery, the women participating in the study answered a questionnaire: demographic information; anthropometric data (pre-pregnancy weight, height, and gestational weight gain); dietary habits information (adherence to MD before and during pregnancy, using the validated Mediterranean Diet Adherence Screener (MEDAS), quality of protein intake); pregnancy information (onset of complications, cesarean/vaginal delivery, gestational age at birth, birth weight, birth length); and clinical practitioner for personalized dietary patterns during pregnancy. Results: A total of 501 respondents have been included in the study, and 135 were excluded for complications. Women who followed the advice of clinical nutritionists showed better adherence to MD (p = 0.02), and the baby’s birth weight was higher (p = 0.02). Significant differences in gestational weight gain (p < 0.01) between groups with dissimilar diet adherence were demonstrated. Conclusion: Our data demonstrate a significant relationship between adherence to MD and birthweight.
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Affiliation(s)
- Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Marco Marchetti
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | - Giuseppe Rizzo
- Division of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy; (G.R.); (I.M.)
- Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
- Correspondence:
| | - Diego Monsignore
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Francesca Dominici
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
| | - Ilenia Mappa
- Division of Gynecology and Obstetrics, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy; (G.R.); (I.M.)
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Tor Vergata University, 00167 Rome, Italy
| | - Ottavia Cavicchioni
- Unit of Obstetrics and Gynecology, Ospedale S. Maria Nuova, 42123 Reggio Emilia, Italy; (O.C.); (L.A.)
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Ospedale S. Maria Nuova, 42123 Reggio Emilia, Italy; (O.C.); (L.A.)
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (D.M.); (F.D.); (A.D.L.)
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16
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Yang S, Zhang Q, Yang B, Li Z, Sun W, Cui L. Analytical and clinical performance evaluation of a new high-sensitivity cardiac troponin I assay. Clin Chem Lab Med 2022; 60:1299-1307. [PMID: 35567358 DOI: 10.1515/cclm-2021-1136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/02/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To validate the analytical performance and diagnostic accuracy for non-ST-segment elevation myocardial infarction (NSTEMI) with a new high-sensitivity cardiac troponin I (hs-cTnI) assay on the automated light-initiated chemiluminescent assay (LiCA®) platform. METHODS Comprehensive analytical validations were performed, and the 99th percentile upper reference limit (URL) from apparently healthy individuals were established. We evaluated the diagnostic performance of the assay for NSTEMI. RESULTS The limit of quantitation (LoQ) were 1.9 ng/L (20% CV) and 5.1 ng/L (10% CV). The sex-specific 99th percentile URLs were 17.6 ng/L (4.2% CV) for men (age 20-79y) and 14.2 ng/L (4.9% CV) for women (age 19-89y) in serum, 14.4 ng/L (4.9% CV) for men (age 19-88y) and 12.9 ng/L (5.2% CV) for women (age 19-87y) in plasma, respectively. Detection rates in healthy individuals were from 98.7 to 99.1%. The correlation coefficient and median bias between LiCA and Architect were 0.985 and 0.1% (-2.0-2.9%) in full analytical range of serum specimens. In lower range (<100 ng/L), LiCA had an overall positive bias 6.7% (-1.6-13.3%), R=0.949. At the specific medical decision levels (15.2, 26.2 and 64.0 ng/L), assay difference was estimated to be <10%. No significant differences on AUC, sensitivity and specificity, NPV and PPV were found between LiCA and Architect for the diagnosis of NSTEMI. CONCLUSIONS LiCA hs-cTnI is a precise, highly sensitive and specific assay that meets the requirement of a 3rd generation (level 4) high-sensitivity method. The diagnostic accuracy of LiCA assay for NSTEMI is comparable to the established Architect hs-cTnI assay.
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Affiliation(s)
- Shuo Yang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Qian Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Boxin Yang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Zijing Li
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Wenyuan Sun
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Liyan Cui
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, P.R. China
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17
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Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095182. [PMID: 35564577 PMCID: PMC9103429 DOI: 10.3390/ijerph19095182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.
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18
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Wauthier L, Plebani M, Favresse J. Interferences in immunoassays: review and practical algorithm. Clin Chem Lab Med 2022; 60:808-820. [PMID: 35304841 DOI: 10.1515/cclm-2021-1288] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Immunoassays are currently the methods of choice for the measurement of a large panel of complex and heterogenous molecules owing to full automation, short turnaround time, high specificity and sensitivity. Despite remarkable performances, immunoassays are prone to several types of interferences that may lead to harmful consequences for the patient (e.g., prescription of an inadequate treatment, delayed diagnosis, unnecessary invasive investigations). A systematic search is only performed for some interferences because of its impracticality in clinical laboratories as it would notably impact budget, turnaround time, and human resources. Therefore, a case-by-case approach is generally preferred when facing an aberrant result. Hereby, we review the current knowledge on immunoassay interferences and present an algorithm for interference workup in clinical laboratories, from suspecting their presence to using the appropriate tests to identify them. We propose an approach to rationalize the attitude of laboratory specialists when faced with a potential interference and emphasize the importance of their collaboration with clinicians and manufacturers to ensure future improvements.
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Affiliation(s)
- Loris Wauthier
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for LIfes Sciences, University of Namur, Namur, Belgium
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19
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OUP accepted manuscript. Eur Heart J 2022; 43:2286-2288. [DOI: 10.1093/eurheartj/ehab924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
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20
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Lam L, Ha L, Heron C, Chiu W, Kyle C. Identification of macrotroponin T: findings from a case report and non-reproducible troponin T results. Clin Chem Lab Med 2021; 59:1972-1980. [PMID: 34496163 DOI: 10.1515/cclm-2021-0626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Macrotroponin is due to cardiac troponin (cTn) binding to endogenous cTn autoantibodies. While previous studies showed a high incidence of macrotroponin affecting cTnI assays, reports of macrotroponin T, particularly without cTnI reactivity, have been rare. Although the clinical significance of macrotroponin is not fully understood, macroenzymes and complexes are recognised to cause confusion in interpretation of laboratory results. The potential for adverse clinical consequences due to misinterpretation of affected results is very high. METHODS We describe four cases of macrotroponin T with persistently low high sensitivity cTnT (hs-cTnT) by the 9 min compared to the 18 min variant of the assay. Three cases were serendipitously identified due to the use of a lot number of Roche hs-cTnT affected by non-reproducible results, necessitating measurement of cTnT in duplicate. We identified and characterised these macrotroponin specimens by immunoglobulin depletion (Protein A and PEG precipitation), mixing studies with EDTA and recombinant cTnT. RESULTS In cases of macro-cTnT, a lower result occurred on the hs-cTnT using the 9 min compared to 18 min variant assay (ratio of 9-18 min hs-cTnT <0.80). Mixing studies with recombinant cTnT or EDTA demonstrated a difference in recovery vs. controls. One of these patients demonstrated a high molecular weight complex for cTnI and cTnT demonstrating a macrocomplex involving both cTn. This patient demonstrated a rise and fall in cTn when measured by several commercial assays consistent with genuine acute cardiac injury. CONCLUSIONS We identified several cases of macro-cTnT and described associated clinical and biochemical features.
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Affiliation(s)
- Leo Lam
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.,Biochemistry Department, Middlemore Hospital Laboratories, Middlemore Hospital, Auckland, New Zealand
| | - Leah Ha
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.,Biochemistry Department, Middlemore Hospital Laboratories, Middlemore Hospital, Auckland, New Zealand
| | - Campbell Heron
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Weldon Chiu
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.,Biochemistry Department, Middlemore Hospital Laboratories, Middlemore Hospital, Auckland, New Zealand
| | - Campbell Kyle
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.,Department of Biochemistry, LabTests, Auckland, New Zealand
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21
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Kavsak PA, Mondoux SE, Martin J, Hewitt MK, Clark L, Caruso N, Mark CT, Chetty VT, Ainsworth C, Worster A. Disagreement between Cardiac Troponin Tests Yielding a Higher Incidence of Myocardial Injury in the Emergency Setting. J Cardiovasc Dev Dis 2021; 8:31. [PMID: 33806960 PMCID: PMC8004643 DOI: 10.3390/jcdd8030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022] Open
Abstract
Differences in patient classification of myocardial injury between high-sensitivity cardiac troponin (hs-cTn) assays have largely been attributed to assay design and analytical sensitivity aspects. Our objective was to compare Ortho Clinical Diagnostics' (OCD) hs-cTnI assay to OCD's contemporary/conventional assay (cTnI ES) and another hs-cTnI assay (Abbott hs-cTnI) in samples obtained from different emergency departments (EDs). Two different sample types were evaluated (lithium heparin and ethylenediaminetetraacetic acid (EDTA) plasma) in a non-selected ED population (study 1, n = 469 samples) and in patients for which ED physicians ordered cardiac troponin testing (study 2, n = 1147 samples), from five different EDs. The incidence of injury in study 1 was higher with the OCD hs-cTnI assay (30.9%; 95% CI: 26.9 to 35.2) compared to that of the Abbott hs-cTnI (17.3%; 95% CI: 14.1 to 21.0) and the OCD cTnI ES (15.4%; 95% CI: 12.4 to 18.9) assays, with repeat testing identifying 4.8% (95% CI: 3.0 to 7.5) of the OCD hs-cTnI results with poor reproducibility. In study 2, 4.6% (95% CI: 3.5 to 6.0) of the results were not reported for the OCD hs-cTnI assay (i.e., poor reproducibility) with 12.7% (95%CI: 8.7 to 17.8) of the OCD hs-cTnI results positive for injury being negative for injury with the Abbott hs-cTnI assay. In summary, the OCD hs-cTnI assay yields higher rates of biochemical injury with a higher rate of poor reproducible results in different ED populations.
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Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (V.T.C.)
- Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada; (L.C.); (N.C.); (C.-T.M.)
| | - Shawn E. Mondoux
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.E.M.); (M.K.H.); (A.W.)
| | - Janet Martin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (V.T.C.)
| | - Mark K. Hewitt
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.E.M.); (M.K.H.); (A.W.)
| | - Lorna Clark
- Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada; (L.C.); (N.C.); (C.-T.M.)
| | - Nadia Caruso
- Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada; (L.C.); (N.C.); (C.-T.M.)
| | - Ching-Tong Mark
- Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada; (L.C.); (N.C.); (C.-T.M.)
| | - V. Tony Chetty
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (V.T.C.)
- Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada; (L.C.); (N.C.); (C.-T.M.)
| | - 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.E.M.); (M.K.H.); (A.W.)
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22
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Kavsak PA. Additional approaches for identifying non-reproducible cardiac troponin results. Clin Chem Lab Med 2021; 59:e267-e270. [PMID: 33711223 DOI: 10.1515/cclm-2021-0091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/03/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Peter A Kavsak
- McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
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