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Kavsak PA, Khattak S, Pogue E, Tandon V. An interference yielding divergent high-sensitivity cardiac troponin results on different instruments from the same manufacturer. Clin Chim Acta 2023; 548:117450. [PMID: 37348628 DOI: 10.1016/j.cca.2023.117450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
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Hammarsten O, Becker C, Engberg AE. Methods for analyzing positive cardiac troponin assay interference. Clin Biochem 2023; 116:24-30. [PMID: 36889375 DOI: 10.1016/j.clinbiochem.2023.03.004] [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: 10/18/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The cardiac damage biomarkers cardiac troponin T (cTnT) and troponin I (cTnI) are used to identify patients with myocardial infarction (MI). To make the correct clinical decisions it is important to identify false positive results due to troponin assay interference. Often interferences are caused by high-molecular weight immunocomplexes called macrotroponin that may result in false troponin elevations because of delayed troponin clearance, or heterophilic antibodies that crosslink troponin assay antibodies and generate troponin-independent signals. DESIGN & METHODS We describe and compare four methods for cTnI assay interference analysis using a protein G spin column method, gel filtration chromatography and two versions of a sucrose gradient ultracentrifugation for cTnI assay interference analysis on five patients with confirmed cTnI interference and one MI patient without cTnI interference from our troponin interference referral center. RESULTS The protein G spin column method had a high between run variability but was still able to identify all five patients with cTnI interference. The sucrose gradient ultracentrifugation methods and the gel filtration method had simlar performancec and correctly identified the immunocomplexes that caused the cTnI interference. CONCLUSIONS Our experience is that these methods are sufficient to safely confirm or exclude positive cTnI assay interference.
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Affiliation(s)
- Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy at University of Gothenburg, SE41345 Gothenburg, Sweden.
| | - Charlotte Becker
- Department of Clinical Chemistry and Pharmacology, Regional and University Laboratories, Region Skåne, Sweden
| | - Anna E Engberg
- Department of Clinical Chemistry and Pharmacology, Regional and University Laboratories, Region Skåne, Sweden
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Brinc D, Vandenberghe H, Kulasingam V, Kavsak PA. Discrepant high-sensitivity cardiac troponin I concentrations when measured on the Abbott Alinity ci versus the Abbott Architect system. Clin Chim Acta 2022; 537:105-106. [PMID: 36228678 DOI: 10.1016/j.cca.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Davor Brinc
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | | | - Vathany Kulasingam
- Division of Clinical Biochemistry, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Storage conditions, sample integrity, interferences, and a decision tool for investigating unusual high-sensitivity cardiac troponin results. Clin Biochem 2022; 115:67-76. [PMID: 35772501 DOI: 10.1016/j.clinbiochem.2022.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
The current definition of high-sensitivity cardiac troponin (hs-cTn) assays is laboratory-based and their analytical attributes and characteristics have drawn significant attention in the literature at least partly due to the lower concentration cut-offs and changes in concentrations (i.e., deltas) employed in different algorithms and pathways to manage patient care. We propose that pre-analytical conditions such as sample type, storage conditions, and other interferences may also have a significant impact on hs-cTn concentrations and clinical management. The purpose of this literature review is to provide a summary of important pre-analytical and interference studies affecting hs-cTn concentrations. A breakdown of the literature for the major diagnostic companies providing core laboratory instrumentation (i.e., Abbott, Beckman, Ortho, Roche, and Siemens) is also provided. Finally, three cases are highlighted where knowledge of pre-analytical factors aids the hs-cTn clinically discordant investigations. This review highlights the importance of pre-analytical variables, especially storage condition, sample handling, and blood tubes used (i.e., sample type) when interpreting hs-cTn assays. Additional studies are needed to further elaborate on pre-analytical variables (i.e., centrifugation, sample type, stability) and interferences for all hs-cTn assays in clinical use, as knowledge of these variables may aid in hs-cTn clinically discordant investigations.
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The imprecision for a high-sensitivity cardiac troponin assay and a CA 19-9 assay in samples with high C-reactive protein concentrations. Clin Chim Acta 2022; 524:192-193. [PMID: 34808114 DOI: 10.1016/j.cca.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
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Drummond S, Mark CT, Caruso N, Clark L, Kavsak PA. Repeat measurements on patient samples identifies unpredictable and poorly reproducible cardiac troponin results with a high-sensitivity cardiac troponin assay. Ann Clin Biochem 2021; 58:677-679. [PMID: 34266289 DOI: 10.1177/00045632211035804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simone Drummond
- Department of Laboratory Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Ching-Tong Mark
- Department of Laboratory Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nadia Caruso
- Department of Laboratory Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lorna Clark
- Department of Laboratory Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Peter A Kavsak
- Department of Laboratory Medicine, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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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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