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Dupuy AM, Badiou S, Montagnon V, Beaufils O, Sebbane M, Roubille F, Cristol JP. Analytical assessment and performance of the 0/3h algorithm with novel high sensitivity cardiac troponin I. Clin Chim Acta 2021; 519:111-117. [PMID: 33838124 DOI: 10.1016/j.cca.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Recently, Ortho Clinical Diagnostics have launched a high sensitivity cardiac troponin I assay adapted on Vitros3600 / 5600. We aimed at evaluating the analytical and clinical performances using the 0/3-hour algorithm, of the Ortho hs-cTnI assay on the Vitros 3600® (Ortho Clinical Diagnostics, Illkirch, France) analyzer with comparison to Roche hs-cTnT assay on the Cobas8000/e801® module (Roche diagnostics, Meylan, France) and the Abbott STAT hs-cTnI assay on the Alinity i® (Abbott, Rungis, France) analyzer. METHODS Imprecision studies, linearity, limit of detection, and the interference to hemolysis were performed for Ortho hs-cTnI assay. The concordance study was based on results of troponin obtained from 160 patients with chest pain to the emergency department. Testing was performed simultaneously measuring the Roche hs-cTnT and the Ortho hs-cTnI, then on remaining sample the concentration of Abbott hs-cTnI (n = 150). We applied the 0/3h algorithm to rule out/rule in, in acute myocardial infarction. RESULTS Analytical performances were acceptable and in accordance with manufacturer's data. For late presenters 100, 92.8 and 88.8% patients could be rule-out with Roche, Ortho and Abbott assay, respectively with one NSTEMI missed with both hs-TnI assays. Applying the hs-cTn cut-offs from 0/3-hour algorithm, 107 (66.8%) could be rule out with Roche hs-cTnT with no AMI missed (sensitivity 100% [95%CI: 90.5 to 100] and NPV 100%); 89 with Ortho hs-cTnI (sensitivity 97.3% [95%CI: 85.8-99.9] and NPV 98.8% [95%CI:92.7-99.8]); and 61 with Abbott hs-cTnI (sensitivity 97% [95%CI: 84.2-99.9] and NPV 98.4% [95%CI: 89.8-99.7]). For rule-in, 23.7% (n = 37) from the total population would be designated in this group, with a specificity of 86.9% (95%CI: 79.7-92.4) and PPV of 69.8% (95%CI: 59.4-78.5) vs specificity of 72.3% (95%CI:63.5-80.0) and PPV of 51.4% (95%CI: 44.1-58.2)with Roche hs-cTnT vs Ortho hs-cTnI respectively; and with Abbott, 33 patients had constitued this group with a specificity of 52.1% (95%CI:42.7-61.4) and PPV of 36.4% (95%CI: 32.0-41.0). CONCLUSION In conclusion, according to ESC guidelines, our results indicate that the Ortho hs-cTnI assay for the Vitros 3600 instrument is a method that may be used in the clinical practice using 0/3-hour algorithm.
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Affiliation(s)
- Anne Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France; Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Valentin Montagnon
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France
| | - Olivier Beaufils
- Département des Urgences, hôpital Lapeyronie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France
| | - Mustapha Sebbane
- Département des Urgences, hôpital Lapeyronie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France
| | - François Roubille
- Département de Cardiologie, hôpital Arnaud de Villeneuve, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France
| | - Jean Paul Cristol
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier F-34295 cédex 5, France; Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France.
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Approaching 2020 acuity for high-sensitivity cardiac troponin assays in Clinical Biochemistry. Clin Biochem 2020; 78:1-3. [PMID: 31991127 DOI: 10.1016/j.clinbiochem.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/23/2022]
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Hickman PE, Abhayaratna WP, Potter JM, Koerbin G. Age-related differences in hs-cTnI concentration in healthy adults. Clin Biochem 2019; 69:26-29. [DOI: 10.1016/j.clinbiochem.2019.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/01/2019] [Accepted: 04/24/2019] [Indexed: 01/07/2023]
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Kavsak PA. Should detectable cardiac troponin concentrations in a healthy population be the only criterion for classifying high-sensitivity cardiac troponin assays? Clin Biochem 2018; 56:1-3. [DOI: 10.1016/j.clinbiochem.2018.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
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Kavsak PA, Andruchow JE, McRae AD, Worster A. Profile of Roche’s Elecsys Troponin T Gen 5 STAT blood test (a high-sensitivity cardiac troponin assay) for diagnosing myocardial infarction in the emergency department. Expert Rev Mol Diagn 2018; 18:481-489. [DOI: 10.1080/14737159.2018.1476141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James E. Andruchow
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Worster
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Wu AHB, Christenson RH, Greene DN, Jaffe AS, Kavsak PA, Ordonez-Llanos J, Apple FS. Clinical Laboratory Practice Recommendations for the Use of Cardiac Troponin in Acute Coronary Syndrome: Expert Opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem 2018; 64:645-655. [DOI: 10.1373/clinchem.2017.277186] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/12/2017] [Indexed: 12/16/2022]
Abstract
Abstract
This document is an essential companion to the third iteration of the National Academy of Clinical Biochemistry [NACB,8 now the American Association for Clinical Chemistry (AACC) Academy] Laboratory Medicine Practice Guidelines (LMPG) on cardiac markers. The expert consensus recommendations were drafted in collaboration with the International Federation of Clinical Chemistry and Laboratory Medicine Task Force on Clinical Applications of Bio-Markers (IFCC TF-CB). We determined that there is sufficient clinical guidance on the use of cardiac troponin (cTn) testing from clinical practice groups. Thus, in this expert consensus document, we focused on clinical laboratory practice recommendations for high-sensitivity (hs)-cTn assays. This document utilized the expert opinion class of evidence to focus on the following 10 topics: (a) quality control (QC) utilization, (b) validation of the lower reportable analytical limits, (c) units to be used in reporting measurable concentrations for patients and QC materials, (d) 99th percentile sex-specific upper reference limits to define the reference interval; (e) criteria required to define hs-cTn assays, (f) communication with clinicians and the laboratory's role in educating clinicians regarding the influence of preanalytic and analytic problems that can confound assay results, (g) studies on hs-cTn assays and how authors need to document preanalytical and analytical variables, (h) harmonizing and standardizing assay results and the role of commutable materials, (i) time to reporting of results from sample receipt and sample collection, and (j) changes in hs-cTn concentrations over time and the role of both analytical and biological variabilities in interpreting results of serial blood collections.
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Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Allan S Jaffe
- Departments of Cardiology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
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8
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Impact of lipid markers and high-sensitivity C-reactive protein on the value of the 99th percentile upper reference limit for high-sensitivity cardiac troponin I. Clin Chim Acta 2016; 462:193-200. [DOI: 10.1016/j.cca.2016.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/01/2016] [Accepted: 09/25/2016] [Indexed: 01/27/2023]
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Kufaishi H, Pardhan A, Krizmanich W, Worster A, Hill S, Kavsak PA. Adopting 'ng/L' as the units for high-sensitivity cardiac troponin assays and commitment by the entire health-care team could be the key for adopting recommendations. Ann Clin Biochem 2016; 53:516-7. [PMID: 26746409 DOI: 10.1177/0004563215613533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Alim Pardhan
- McMaster University, Hamilton, Ontario, Canada Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - William Krizmanich
- McMaster University, Hamilton, Ontario, Canada Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew Worster
- McMaster University, Hamilton, Ontario, Canada Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stephen Hill
- McMaster University, Hamilton, Ontario, Canada Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Peter A Kavsak
- McMaster University, Hamilton, Ontario, Canada Hamilton Health Sciences, Hamilton, Ontario, Canada
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Kavsak PA, Beattie J, Pickersgill R, Ford L, Caruso N, Clark L. A practical approach for the validation and clinical implementation of a high-sensitivity cardiac troponin I assay across a North American city. Pract Lab Med 2015; 1:28-34. [PMID: 28932796 PMCID: PMC5597710 DOI: 10.1016/j.plabm.2015.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/20/2015] [Accepted: 02/11/2015] [Indexed: 02/03/2023] Open
Abstract
Objectives Despite several publications on the analytical performance of high-sensitivity cardiac troponin (hs-cTn) assays, there has been little information on how laboratories should validate and implement these assays into clinical service. Our study provides a practical approach for the validation and implementation of a hs-cTn assay across a large North American City. Design and methods Validation for the Abbott ARCHITECT hs-cTnI assay (across 5 analyzers) consisted of verification of limit of blank (LoB), precision (i.e., coefficient of variation; CV) testing at the reported limit of detection (LoD) and within and outside the 99th percentile, linearity testing, cTnI versus hs-cTnI patient comparison within and between analyzers (Passing and Bablok and non-parametric analyses). Education, clinical communications, and memorandums were issued in advance to inform all staff across the city as well as a selected reminder the day before live-date to important users. All hospitals switched to the hs-cTnI assay concurrently (the contemporary cTnI assay removed) with laboratory staff instructed to repeat samples previously measured with the contemporary cTnI assay with the hs-cTnI assay only by physician request. Results Across the 5 analyzers and 6 reagent packs the overall LoB was 0.6 ng/L (n=60) with a CV of 33% at an overall mean of 1.2 ng/L (n=60; reported LoD=1.0 ng/L), with linearity demonstrated from 45,005 ng/L to 1.1 ng/L. Precision testing with a normal patient-pool QC material (mean range across 5 analyzers was 3.9–4.4 ng/L) yielded a range of CVs from 7% to 10% (within-run) and CVs from 7% to 18% (between-run) with the high patient-pool QC material (mean range across 5 analyzers was 29.6–36.3 ng/L) yielding a range of CVs from 2% to 5% (within-run) and CVs from 4% to 8% (between-run). There was agreement between hs-cTnI versus cTnI with the patient samples (slope ranges: 0.89–1.03; intercept ranges: 1.9–3.8 ng/L), however, the median CV on patient samples <100 ng/L across the analyzers was 5.6% for hs-cTnI versus 18.7% for the contemporary assay (p<0.001). Following the switch to hs-cTnI testing, no requests for repeat measurements were received. Conclusions Validation and implementation of hs-cTnI testing across multiple sites requires collaboration within the laboratories and between hospital laboratories and clinical staff. City-wide analytical validation of a high-sensitivity cardiac troponin assay. Practical approach to hs-cTnI validation and clinical implementation. Clinical support and communication are important for a successful implementation. New QC practices and comparability testing for hs-cTnI monitoring.
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Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, Canada
- Hamilton Regional Laboratory Medicine Program, Canada
- Correspondence to: Juravinski Hospital and Cancer Centre, 711 Concession Street Hamilton, ON, Canada L8V 1C3. Tel.: +1 905 521 2100.
| | - John Beattie
- Hamilton Regional Laboratory Medicine Program, Canada
- Hamilton General Hospital, Hamilton, Canada
| | - Robin Pickersgill
- Hamilton Regional Laboratory Medicine Program, Canada
- St. Joseph׳s Hospital, Hamilton, Canada
| | - Lynn Ford
- Hamilton Regional Laboratory Medicine Program, Canada
- McMaster Children׳s Hospital, Hamilton, Canada
| | - Nadia Caruso
- Hamilton Regional Laboratory Medicine Program, Canada
- Hamilton General Hospital, Hamilton, Canada
| | - Lorna Clark
- Juravinski Hospital and Cancer Centre, Hamilton, Canada
- Hamilton Regional Laboratory Medicine Program, Canada
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11
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IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem 2015; 48:201-3. [DOI: 10.1016/j.clinbiochem.2014.08.021] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022]
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12
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Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review. Clin Biochem 2015; 48:204-12. [PMID: 25661303 DOI: 10.1016/j.clinbiochem.2015.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. DESIGN AND METHODS The CDC-funded Laboratory Medicine Best Practices (LMBP) Initiative systematic review method for quality improvement practices was used. RESULTS The current ACC/AHA guidelines recommend using cardiac troponin assays with a 99th percentile upper reference limit (URL) diagnostic threshold to diagnose NSTEMI. The evidence in this systematic review indicates that contemporary sensitive cTn assays meet the assay profile requirements (sensitivity, specificity, PPV, and NPV) to more accurately diagnose NSTEMI than alternate tests. Additional biomarkers did not increase diagnostic effectiveness of cTn assays. Sensitivity, specificity, and NPV were consistently high and low PPV improved with serial sampling. Evidence for use of point of care cTn testing was insufficient to make recommendation, though some evidence suggests that use may result in reduction to patient length of stay and costs. CONCLUSIONS Based on the review of and the LMBP(TM) A-6 Method criteria, we recommend the use of cardiac troponin assays without additional biomarkers using the 99th percentile URL as the clinical diagnostic threshold for the diagnosis of NSTEMI. We recommend serial sampling with one sample at presentation and at least one additional second sample taken at least 6h later to identify a rise or fall in the troponin level. No recommendation is made either for or against the use of point of care tests. DISCLAIMER The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).
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Kavsak PA, Jaffe AS, Hickman PE, Mills NL, Humphries KH, McRae A, Devereaux PJ, Lamy A, Whitlock R, Dhesy-Thind SK, Potter JM, Worster A. Canadian Institutes of Health Research dissemination grant on high-sensitivity cardiac troponin. Clin Biochem 2014; 47:155-7. [PMID: 25304912 DOI: 10.1016/j.clinbiochem.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Peter E Hickman
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Nicholas L Mills
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Andrew McRae
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andre Lamy
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Julia M Potter
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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Wu AH, Christenson RH. Analytical and assay issues for use of cardiac troponin testing for risk stratification in primary care. Clin Biochem 2013; 46:969-978. [DOI: 10.1016/j.clinbiochem.2013.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 12/21/2022]
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Danese E, Montagnana M, Giudici S, Aloe R, Franchi M, Guidi GC, Lippi G. Highly-sensitive troponin I is increased in patients with gynecological cancers. Clin Biochem 2013; 46:1135-1138. [PMID: 23660299 DOI: 10.1016/j.clinbiochem.2013.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/22/2013] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate troponin I (TnI) in patients with gynecological cancers. METHODS Highly-sensitive (HS) and conventional TnI were measured in 25 patients with untreated ovarian cancer, 25 with endometriosis and 25 with benign masses. RESULTS Both HS and conventional TnI were increase in cancer patients. Values above the cut-off were found in 44% and 16% cancer patients using HS and conventional TnI methods, respectively. CONCLUSIONS Cardiac involvement is frequent in patients with gynecological cancers and should be preferably assessed using HS troponin immunoassays.
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Affiliation(s)
- Elisa Danese
- Sezione di Biochimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università degli Studi di Verona, Verona, Italy.
| | - Martina Montagnana
- Sezione di Biochimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università degli Studi di Verona, Verona, Italy
| | - Silvia Giudici
- Unità di Ginecologia ed Ostetricia, Dipartimento di Scienze della Vita e della Riproduzione, Università degli studi di Verona, Italy
| | - Rosalia Aloe
- U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Massimo Franchi
- Unità di Ginecologia ed Ostetricia, Dipartimento di Scienze della Vita e della Riproduzione, Università degli studi di Verona, Italy
| | - Gian Cesare Guidi
- Sezione di Biochimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università degli Studi di Verona, Verona, Italy
| | - Giuseppe Lippi
- U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy
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Lippi G, Mattiuzzi C, Cervellin G. Critical review and meta-analysis on the combination of heart-type fatty acid binding protein (H-FABP) and troponin for early diagnosis of acute myocardial infarction. Clin Biochem 2013; 46:26-30. [DOI: 10.1016/j.clinbiochem.2012.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 12/24/2022]
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Aw TC. High Sensitivity Troponins — Translating Research into Practice. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Troponin is vital in the evaluation of acute coronary syndrome. Decision limits, based on the 99th percentile upper reference limit derived from a sufficiently large normal reference population, must be determined for each specific troponin method. The new troponins exhibit high-sensitivity performance – assay precision at less than 10% coefficient of variation (at the 99th percentile upper reference limit) and ability to detect measurable values in healthy subjects. The troponin literature has reached a tipping point necessitating guidance on its use from specialist societies.
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Affiliation(s)
- Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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18
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Kavsak PA, Worster A. For a rapid diagnosis of acute myocardial infarction, a sensitive troponin assay is needed in the near-patient testing setting. Expert Rev Cardiovasc Ther 2012; 10:309-12. [PMID: 22390802 DOI: 10.1586/erc.11.197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An early diagnosis of myocardial infarction in the emergency setting would be advantageous for both patients and the physicians treating these patients. Guidelines currently recommend serial samples that are drawn at presentation and 6-9 h later to be measured for cardiac troponin to aid in this diagnosis. However, much effort has been directed to decrease the time to make a diagnosis in this setting, and there has been renewed interest in shortening the time between serial measurements as well as the turnaround time for reporting the results. By eliminating the blood sample transit time to the central laboratory, point-of-care testing or near-patient testing can reduce the turnaround time for reporting the results, however this is possibly at the cost of decreased diagnostic performance. In this article, we discuss the recent results from the RATPAC study, which evaluated whether the combination of myoglobin, the MB isoenzyme of creatine kinase (CKMB) and a sensitive troponin assay would be superior to troponin alone.
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Affiliation(s)
- Peter A Kavsak
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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Vasikaran SD, Bima A, Botros M, Sikaris KA. Cardiac troponin testing in the acute care setting: Ordering, reporting, and high sensitivity assays—an update from the Canadian society of clinical chemists (CSCC); the case for age related acute myocardial infarction (AMI) cut-offs. Clin Biochem 2012; 45:513-4. [DOI: 10.1016/j.clinbiochem.2012.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/05/2012] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
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Kavsak PA, Hill SA, Bhanich Supapol W, Devereaux PJ, Worster A. Biomarkers for Predicting Serious Cardiac Outcomes at 72 Hours in Patients Presenting Early after Chest Pain Onset with Symptoms of Acute Coronary Syndromes. Clin Chem 2012; 58:298-302. [DOI: 10.1373/clinchem.2011.172064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Most outcome studies of patients presenting early to the emergency department with potential acute coronary syndromes have focused on either the index diagnosis of myocardial infarction (MI) or a composite end point at a later time frame (30 days or 1 year). We investigated the performance of 9 biomarkers for an early serious outcome.
METHODS
Patients (n = 186) who presented to the emergency department within 6 h of chest pain onset had their presentation serum sample measured for the following analytes: creatine kinase, creatine kinase isoenzyme MB, enhanced AccuTnI troponin I (Beckman Coulter), high-sensitivity cardiac troponin T (hs-cTnT), ischemia-modified albumin, interleukin-6, investigation use only hs-cTnI (Beckman Coulter), N-terminal pro–B-type natriuretic peptide, and cardiac troponin I (Abbott AxSym). We followed patients until 72 h after presentation and determined whether they experienced the following serious cardiac outcomes: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death. ROC curves were analyzed to determine the area under the ROC curve (AUC) and optimal cutoffs for the biomarkers.
RESULTS
The AUCs for the hs-cTnI assay (0.86; 95% CI, 0.76–0.96), the AccuTnI assay (0.86; 95% CI, 0.78–0.95), and the hs-cTnT assay (0.82; 95% CI, 0.71–0.94) assays were significantly higher than those for the other 6 assays (AUC values ≤0.71 for the rest of the biomarkers, P < 0.05). The ROC curve–derived optimal cutoffs were ≥19 ng/L (diagnostic sensitivity, 80%; specificity, 88%), ≥0.018 μg/L (diagnostic sensitivity, 75%; specificity, 86%), and ≥32 ng/L (diagnostic sensitivity, 68%; specificity, 92%) for the hs-cTnI, AccuTnI, and hs-cTnT assays, respectively.
CONCLUSIONS
The optimal cutoffs for predicting serious cardiac outcomes in this low-risk population are different from the published 99th percentiles. Larger studies are required to verify these findings.
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Affiliation(s)
| | | | | | | | - Andrew Worster
- Medicine, McMaster University, Hamilton, Ontario, Canada
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Guidi GC, Lippi G. Molar expression: Interconverting results of highly sensitive troponin I and T while preserving clinical significance. Clin Biochem 2012; 45:183. [DOI: 10.1016/j.clinbiochem.2011.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022]
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