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Shinde V, Dixit Y, Penmetsa P, Luthra A. Comparative Study of Laboratory Versus Bedside High-Sensitivity Troponin I in the Emergency Medicine Department of a Tertiary Care Hospital in India. Cureus 2024; 16:e66512. [PMID: 39246852 PMCID: PMC11381107 DOI: 10.7759/cureus.66512] [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: 07/10/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Evaluating high-sensitivity troponin I levels in emergency medicine is critical for diagnosing acute myocardial infarction (AMI). This study aims to evaluate the central laboratory versus bedside troponin I test in the emergency department of a tertiary care center. MATERIAL AND METHODS This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from October to December 2023. Patient samples were analyzed in the central laboratory using the Dimension EXL 200 (Siemens® Healthcare Diagnostics Inc., Erlangen, Germany) as the gold standard test and through point-of-care testing using the TriageTrue® (Quidel Corporation, San Diego, CA) high-sensitivity troponin I kit, which was run on the Triage® MeterPro® device (Quidel Corporation, San Diego, CA). This device quantitatively determines troponin I in ethylenediaminetetraacetic acid-anticoagulated whole blood and plasma specimens. The results were compared. Statistical analysis was performed using SPSS version 18 (SPSS Inc., Chicago, IL). An unpaired t-test was performed to compare the difference in time taken using the two testing methods. RESULT The mean time for obtaining troponin I results was substantially shorter with bedside testing (14.91 minutes, standard deviation (SD) = 0.5) than with laboratory testing (119.1 minutes, SD = 5.03). Statistical analysis revealed a significant difference (t = -172.36, p < 0.001). A chi-square test was conducted to assess the disparity between the two testing methods, yielding a chi-square value of 32.64 and a p value of 0.00001, indicating a significant difference between bedside testing and laboratory testing. CONCLUSION The bedside high-sensitivity troponin I test offers a considerable advantage over laboratory testing regarding turnaround time within the emergency medicine department in India. This rapid diagnostic capability is crucial for timely management, which is beneficial for patients inconclusive of acute coronary syndrome-like non-ST segment elevation myocardial infarction (NSTEMI). It is also cost-effective. It also reduces the emergency boarding time and may reduce the number of unnecessary admissions in healthcare facilities.
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Affiliation(s)
- Varsha Shinde
- Department of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Yash Dixit
- Department of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Pranay Penmetsa
- Department of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Avinav Luthra
- Department of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
- Department of Emergency Medicine, United Institute of Medical Sciences, Prayagraj, IND
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Comparison of Point-of-Care and Highly Sensitive Laboratory Troponin Testing in Patients Suspicious of Acute Myocardial Infarction and Its Efficacy in Clinical Outcome. Cardiol Res Pract 2022; 2022:6914979. [PMID: 35251711 PMCID: PMC8894057 DOI: 10.1155/2022/6914979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background The use of high-sensitivity troponin (hs-cTnI) assays is recommended in current guidelines for managing patients with acute coronary syndrome (ACS) symptoms. However, point-of-care (POC) assays are frequently used in emergency departments (EDs) to reduce turnaround time and length of stay. This study aimed to compare the results of POC-cTnI testing with those of the gold standard, automated central laboratory testing of troponin (i.e., hs-cTnI). The primary and secondary outcomes were the diagnostic performance of POC-cTnI in diagnosing acute myocardial infarction (AMI) and major adverse cardiovascular events (MACE) during 30 days, respectively. Materials and Methods In this diagnostic accuracy study, 136 patients with suspected ACS who were referred or admitted to the Al Zahra Hospital, Shiraz, Iran, were included between March (2020) and July (2020). For the diagnosis of AMI, central laboratory cTnI levels were assessed at the time of presentation (0 hour) and reassessed at least 3 hours later. The POC-cTnI was measured at 0 hour in all patients and at 3 hours if a patient was diagnosed with AMI but had a 0-hour negative result for the POC-cTnI assay. Additionally, the 30-day follow-up period for these participants began on the day of the initial presentation to assess MACE. Results Out of 180 patients, 136 patients (median age of 59.5 years; 57.5% male) were left for the qualitative POC-cTnI and hs-cTnI assays. In 86 (63.24%) subjects, hs-cTnI was positive (either initial or serial); however, AMI was diagnosed in 85 patients according to positivity of troponin by hs-cTnI and clinical signs and symptoms, which were diagnosed by a cardiologist. The sensitivity, specificity, and negative predictive value of 0-hour POC-cTnI were observed to be 91.76% (95% CI: 83.77–96.62%), 98.04% (95% CI: 89.55–99.95%), and 87.72% (95% CI: 77.82–93.56%), respectively. Moreover, considering both the 0-hour and 3-hour POC-cTnI, all AMI cases were correctly identified, yielding a perfect test performance result. None of the 50 patients with negative cTnI results (by 0-hour and 3-hour POC-cTnI and hs-cTnI) experienced at least one MACE. Conclusion In this small sample-size study, a new qualitative POC-cTnI assay was statistically equal to a hs-cTnI assay in terms of diagnostic accuracy for AMI or MACE in patients with suspected myocardial infarction. The POC-cTnI was observed to be acceptable for the identification of AMI and prediction of MACE in the ED environment.
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Modeling Hypoxic Stress In Vitro Using Human Embryonic Stem Cells Derived Cardiomyocytes Matured by FGF4 and Ascorbic Acid Treatment. Cells 2021; 10:cells10102741. [PMID: 34685725 PMCID: PMC8534799 DOI: 10.3390/cells10102741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Mature cardiomyocytes (CMs) obtained from human pluripotent stem cells (hPSCs) have been required for more accurate in vitro modeling of adult-onset cardiac disease and drug discovery. Here, we found that FGF4 and ascorbic acid (AA) induce differentiation of BG01 human embryonic stem cell–cardiogenic mesoderm cells (hESC-CMCs) into mature and ventricular CMs. Co-treatment of BG01 hESC-CMCs with FGF4+AA synergistically induced differentiation into mature and ventricular CMs. FGF4+AA-treated BG01 hESC-CMs robustly released acute myocardial infarction (AMI) biomarkers (cTnI, CK-MB, and myoglobin) into culture medium in response to hypoxic injury. Hypoxia-responsive genes and potential cardiac biomarkers proved in the diagnosis and prognosis of coronary artery diseases were induced in FGF4+AA-treated BG01 hESC-CMs in response to hypoxia based on transcriptome analyses. This study demonstrates that it is feasible to model hypoxic stress in vitro using hESC-CMs matured by soluble factors.
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Regan B, O'Kennedy R, Collins D. Advances in point-of-care testing for cardiovascular diseases. Adv Clin Chem 2021; 104:1-70. [PMID: 34462053 DOI: 10.1016/bs.acc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Point-of-care testing (POCT) is a specific format of diagnostic testing that is conducted without accompanying infrastructure or sophisticated instrumentation. Traditionally, such rapid sample-to-answer assays provide inferior analytical performances to their laboratory counterparts when measuring cardiac biomarkers. Hence, their potentially broad applicability is somewhat bound by their inability to detect clinically relevant concentrations of cardiac troponin (cTn) in the early stages of myocardial injury. However, the continuous refinement of biorecognition elements, the optimization of detection techniques, and the fabrication of tailored fluid handling systems to manage the sensing process has stimulated the production of commercial assays that can support accelerated diagnostic pathways. This review will present the latest commercial POC assays and examine their impact on clinical decision-making. The individual elements that constitute POC assays will be explored, with an emphasis on aspects that contribute to economically feasible and highly sensitive assays. Furthermore, the prospect of POCT imparting a greater influence on early interventions for medium to high-risk individuals and the potential to re-shape the paradigm of cardiovascular risk assessments will be discussed.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin, Ireland.
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin, Ireland
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Mohammad OH, Naushad VA, Purayil NK, Sinan L, Ambra N, Chandra P, Paramba FC, Mohammad J, Chalihadan S, Varikkodan I, Palol A. Diagnostic Performance of Point-of-Care Troponin I and Laboratory Troponin T in Patients Presenting to the ED with Chest Pain: A Comparative Study. Open Access Emerg Med 2020; 12:247-254. [PMID: 33116960 PMCID: PMC7575355 DOI: 10.2147/oaem.s259726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain. Methods A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared. Results Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours. Conclusion Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.
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Affiliation(s)
- Osama H Mohammad
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Vamanjore A Naushad
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nishan K Purayil
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Naseem Ambra
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Firjeeth C Paramba
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Mohammad
- Accident & Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Sajid Chalihadan
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Irfan Varikkodan
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Azeez Palol
- Department of General Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Collinson P. Cardiac biomarker measurement by point of care testing - Development, rationale, current state and future developments. Clin Chim Acta 2020; 508:234-239. [PMID: 32464138 DOI: 10.1016/j.cca.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
Cardiac biomarker measurements are integral to the diagnosis and management of patients presenting with breathlessness and chest pain. Measurement of B type natriuretic peptide either directly or of the N-terminal portion of the prohormone although possible by point of care testing (POCT) has largely become a laboratory test. Measurement of the cardiac troponins cardiac troponin T (cTnT) and cardiac troponin I (cTnI) can easily and accurately be performed by POCT. The situation has been complicated by the development of high sensitivity assays for cTnT and cTnI and the subsequent development of rapid rule out algorithms allowing patient categorisation and discharge on admission and 1 to 2 h following admission. This article reviews the development of POCT for cardiac biomarkers, the evidence base comparing POCT with central laboratory testing, its strengths and limitations, and how POCT fits into the world of high sensitivity troponin assays. It also discusses what evidence there is that POCT can form part of rapid decision-making strategies and how this applies in an era of algorithms based on and is derived from measurement of high sensitivity troponin in the central laboratory.
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Affiliation(s)
- Paul Collinson
- Departments of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, Cranmer Terrace, London SW17 0QT, UK.
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Gopinathan P, Sinha A, Chung YD, Shiesh SC, Lee GB. Optimization of an enzyme linked DNA aptamer assay for cardiac troponin I detection: synchronous multiple sample analysis on an integrated microfluidic platform. Analyst 2019; 144:4943-4951. [PMID: 31317135 DOI: 10.1039/c9an00779b] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this study, an enzyme linked DNA aptamer based assay was optimized for human cardiac troponin I (cTnI) detection which is a prominent biomarker for acute myocardial infarction (AMI), on an integrated microfluidic platform. This platform allowed for the multiplex detection of six samples (5 μL per sample), and only 30 min were required for detection. First, cTnI-specific aptamers were surface-coated on magnetic beads. Bead-captured proteins were allowed to bind to a primary cTnI antibody and then to a secondary antibody labelled with horseradish peroxidase. Finally, chemiluminescence intensities were detected for quantification of cTnI. Purified proteins, serum from AMI patients and unknown serum samples were used to test the efficacy of the on-chip system. The limit of detection was measured to be only 12 ng L-1, and off-target effects from other proteins were minimal. This sensitive, cTnI-specific aptamer-based assay could consequently be used for reliable diagnosis of AMI.
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Affiliation(s)
- Priya Gopinathan
- Institute of NanoEngineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan
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Regan B, Boyle F, O'Kennedy R, Collins D. Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3485. [PMID: 31395843 PMCID: PMC6720456 DOI: 10.3390/s19163485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
Molecular imprinting is a rapidly growing area of interest involving the synthesis of artificial recognition elements that enable the separation of analyte from a sample matrix and its determination. Traditionally, this approach can be successfully applied to small analyte (<1.5 kDa) separation/ extraction, but, more recently it is finding utility in biomimetic sensors. These sensors consist of a recognition element and a transducer similar to their biosensor counterparts, however, the fundamental distinction is that biomimetic sensors employ an artificial recognition element. Molecularly imprinted polymers (MIPs) employed as the recognition elements in biomimetic sensors contain binding sites complementary in shape and functionality to their target analyte. Despite the growing interest in molecularly imprinting techniques, the commercial adoption of this technology is yet to be widely realised for blood sample analysis. This review aims to assess the applicability of this technology for the point-of-care testing (POCT) of cardiovascular disease-related biomarkers. More specifically, molecular imprinting is critically evaluated with respect to the detection of cardiac biomarkers indicative of acute coronary syndrome (ACS), such as the cardiac troponins (cTns). The challenges associated with the synthesis of MIPs for protein detection are outlined, in addition to enhancement techniques that ultimately improve the analytical performance of biomimetic sensors. The mechanism of detection employed to convert the analyte concentration into a measurable signal in biomimetic sensors will be discussed. Furthermore, the analytical performance of these sensors will be compared with biosensors and their potential implementation within clinical settings will be considered. In addition, the most suitable application of these sensors for cardiovascular assessment will be presented.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin 9, Ireland.
| | - Fiona Boyle
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
- Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
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Christenson RH, Mullins K, Duh SH. Validation of high-sensitivity performance for a United States Food and Drug Administration cleared cardiac troponin I assay. Clin Biochem 2018; 56:4-10. [PMID: 29750939 DOI: 10.1016/j.clinbiochem.2018.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/30/2018] [Accepted: 05/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND High-Sensitivity (hs) cardiac troponin (cTn) assays are categorized by two criteria: (i) cTn values above the limit of detection (LoD) for >50% of male and female healthy cohorts of ≥300 individuals; (ii) imprecision ≤10% total %CV for sex-specific 99th-percentile clinical decision values (CDVs). No documented hs-Tn assay has yet been FDA-cleared. METHODS The PATHFAST cTnI-II assay's LoD was 2.3 ng/L using CLSI EP-17. The AACC Universal Sample Bank of 847 healthy men (50.6%) and women (49.4%) was used to determine 99th-percentile CDVs with Nonparametric, Harrell-Davis and Robust modeling. Health/Medication questionnaires and Amino-terminal proBNP, Hemoglobin A1c and estimated Glomerular Filtration Rate surrogates excluded underlying health conditions. RESULTS The cTnI-II test's total CV was 6.1% at 29 ng/L and 7.1% at 22 ng/L; the LoD was 2.3 ng/L. Of the full 847-member healthy cohort, 113 (13.3%) were excluded by abnormal surrogate biomarkers. The final 734-member healthy population had the following (% > LoD): overall, 487 (66.3%); women, 186 (52.8%); and men, 301 (78.8%). 99th-percentile CDVs by Nonparametric modeling were: 28 ng/L (90% CI: 20-30), overall final 732-member healthy population; 20 ng/L (90% CI: 13-30), 352 women; and 30 ng/L (90% CI: 21-37), 382 men. Differences between sex-specific CDVs were not significantly different (p > .05) with Nonparametric or Harrell-Davis modeling; however, Robust Modeling did show significance (<0.05), with lower CDVs at 11 ng/L (90% CI: 9-12) and 16 ng/L (90% CI: 15-18) for the female and male cohorts, respectively. CONCLUSIONS cTnI-II is the only FDA-cleared assay that has demonstrated high-sensitivity cTn assay. Use of recommended modeling in >300 healthy subjects for determining sex-specific 99th-percentile CDVs did not show statistically significant differences except with the Robust modeling.
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Affiliation(s)
- Robert H Christenson
- University of Maryland School of Medicine, Department of Pathology, 685 West Baltimore Street, MSTF Room 2-54, Baltimore, MD 21201, USA.
| | - Kristin Mullins
- University of Maryland School of Medicine, Department of Pathology, 685 West Baltimore Street, MSTF Room 2-54, Baltimore, MD 21201, USA
| | - Show-Hong Duh
- University of Maryland School of Medicine, Department of Pathology, 685 West Baltimore Street, MSTF Room 2-54, Baltimore, MD 21201, USA
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Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI. Pract Lab Med 2018; 11:23-32. [PMID: 30014015 PMCID: PMC6045566 DOI: 10.1016/j.plabm.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives We aimed to compare the use of nine different cardiac troponin (cTn) assays (2 cTnT and 7 cTnI) for the diagnosis of NSTEMI in a single multi-centre population. Design and methods One hundred and fifty-eight patients were included (mean age 60 years, SD 17 years), including 23 patients (14%) with NSTEMI. Results The analytical comparison highlighted a large heterogeneity of cTn assays, as reflected by percentages of patients with detectable cTn, correlation coefficients, Passing-Bablok comparisons and concordance coefficients. Correlations within cTnI assays were good and correlation within cTnT assays was excellent. Diagnostic performances demonstrated that each cTn assay has specific threshold values. Furthermore, some assays (HS-cTnI and T, cTnI-Pathfast and cTnI-Centaur) indicated high sensitivity and negative predictive value using the limit of detection (LoD) diagnostic strategy. For the latter assays, a significant increase in specificity was found when using the 99th percentile or the H0-H3 strategies, in comparison to the LoD strategy. When applying the European Society of Cardiology H0-H3 algorithm, comparable diagnostic performances were obtained. Conclusion All 9 cTn assays indicated overall good diagnostic performances for the diagnosis of NSTEMI in emergency departments when the recommended algorithm based on the variation of cTn value between two measurements at admission and 3 h later was used. We compare nine troponin assays for the diagnosis of NSTEMI. Each cTn assay owns specific thresholds for the ESC H0-H3 algorithm. All assays present high specificity for NSTEMI diagnosis using H0-H3 algorithm. Assay-specific threshold and delta change values for each cTn assays are mandatory.
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Christenson RH, Jacobs E, Uettwiller-Geiger D, Estey MP, Lewandrowski K, Koshy TI, Kupfer K, Li Y, Wesenberg JC. Comparison of 13 Commercially Available Cardiac Troponin Assays in a Multicenter North American Study. ACTA ACUST UNITED AC 2017; 1:544-561. [DOI: 10.1373/jalm.2016.022640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/27/2016] [Indexed: 11/06/2022]
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