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Kempton H, Jones G, McCready M, Kovacic J. Macrotroponin in the COVID-19 Era: An Under-Recognised Cause of Persistent Troponin Elevation. Heart Lung Circ 2024:S1443-9506(24)00168-9. [PMID: 38705780 DOI: 10.1016/j.hlc.2024.03.007] [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: 11/01/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 05/07/2024]
Abstract
Troponin is an important diagnostic tool, however, as the assay sensitivity and frequency of testing has increased in the COVID-19 era, a new cohort of patients with persistently elevated troponin has emerged. Interfering antibodies should be considered in patients with persistent and stable troponin elevation, where there is no ongoing cause.
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Affiliation(s)
- Hannah Kempton
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia.
| | - Graham Jones
- Department of Pathology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Michael McCready
- Department of Cardiology, Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia
| | - Jason Kovacic
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The University of New South Wales, Sydney, NSW, Australia; The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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2
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Lam L, Kyle C. Practical approaches to the detection of macrotroponin. Ann Clin Biochem 2024; 61:122-132. [PMID: 37578158 DOI: 10.1177/00045632231197301] [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] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Macrotroponin is increasingly recognised as a cause of confusion in interpreting high-sensitivity cardiac troponin (hs-cTnI) results. In this study, we sought to evaluate two practical approaches to detecting macrotroponin. These two approaches are PEG precipitation and SVM (support vector machine) analysis to classify discrepancies between hs-cTn assays. METHOD Residual serum and heparin plasma specimens (n = 483) with initially elevated hs-cTnI from hospital and community laboratories were retested on multiple hs-cTn platforms before and after PEG precipitation and Protein A immunoglobulin depletion. SVM analysis was conducted to identify a linear equation that best discriminated specimens with macrotroponin using a combination of results from two different hs-cTn assays. FINDINGS The diagnostic performance of PEG precipitation was carried out using Protein A immunoglobulin depletion as the reference comparator. When a cutoff residual activity after PEG precipitation of ≤ 20% was used, this threshold carried a high specificity of 92% (confidence interval 83-98%; n = 189) using the Siemens hs-cTnI Vista assay and 95% specificity (86%-98%; n = 242) using the Abbott hs-cTnI Architect assay. SVM analysis generated a linear equation identifying macrotroponin specimens from results obtained on two hs-cTn assays. This approach can be highly specific, comparable to PEG precipitation when certain assay combinations and concentrations are used. CONCLUSION We describe and identify practical alternatives to detecting macrotroponin. These approaches can be optimised for high specificity, reducing the need for more complex laboratory methods.
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Affiliation(s)
- Leo Lam
- Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Biochemistry, Middlemore Hospital Laboratories, Auckland, New Zealand
| | - Campbell Kyle
- Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Biochemistry, Labtests, Auckland, New Zealand
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3
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McEvoy JW, Wang D, Tang O, Fang M, Ndumele CE, Coresh J, Christenson RH, Selvin E. Four high sensitivity troponin assays and mortality in US adults with cardiovascular disease: The national health and nutrition examination survey, 1999-2004. Am J Prev Cardiol 2024; 17:100631. [PMID: 38304389 PMCID: PMC10832369 DOI: 10.1016/j.ajpc.2023.100631] [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: 10/04/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
Objective High sensitivity cardiac troponin (hs-cTn) may be useful to monitor residual risk in secondary prevention. Our objective was to study the correlations and comparative associations with mortality of four hs-cTn assays in US adults with known cardiovascular disease (CVD). Methods We studied 1,211 adults with a history of CVD who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Using stored samples, we measured hs-cTnT (Roche) and three hs-cTnI assays (Abbott, Siemens, and Ortho). Outcomes were all-cause and CVD mortality, with follow-up through December 31, 2019. Results Mean age was 64 years, 48 % were female, and 80 % identified as non-Hispanic White. Pearson's correlation coefficients between hs-cTn assays ranged from 0.67 to 0.85. There were 848 deaths (365 from CVD). Among adults with a history of prior non-fatal CVD, each hs-cTn assay (log-transformed, per 1-SD) was independently associated with CVD death (HRs ranging from 1.55 to 2.16 per 1-SD, all p-values <0.05) and with all-cause death (HRs ranging from 1.31 to 1.62 per 1-SD, all p-values <0.05). Associations of hs-cTnT and all-cause and CVD death remained significant after adjusting for hs-cTnI (and vice versa). Associations between hs-cTnI and CVD death remained significant after mutually adjusting for other individual hs-cTnI assays: e.g., HR 2.21 (95 % CI 1.60, 3.05) for Ortho (hs-cTnI) after adjustment for Siemens (hs-cTnI) and HR 1.81 (95 % CI 1.35, 2.43) for Ortho (hs-cTnI) after adjustment for Abbott (hs-cTnI). Conclusion In US adults with a history of CVD, we found modest correlations between 4 hs-cTn assays. All assays were associated with all-cause and CVD mortality. The hs-cTnT assay was associated with mortality independent of the hs-cTnI assays. Hs-cTnI assays also appeared to be independent of each other. Thus, hs-cTn assays may provide distinct information for residual risk in secondary prevention adults.
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Affiliation(s)
- John W. McEvoy
- Department of Cardiology & National Institute for Prevention & Cardiovascular Health, University of Galway, Ireland
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dan Wang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olive Tang
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Fang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chiadi E. Ndumele
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore,aryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Clerico A, Zaninotto M, Plebani M. Rapid rule-in and rule-out protocols of acute myocardial infarction using hs-cTnI and hs-cTnT methods. Clin Chem Lab Med 2024; 62:213-217. [PMID: 37736000 DOI: 10.1515/cclm-2023-1010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Aldo Clerico
- Study Group on Cardiac Biomarkers of the Italian Societies of Laboratory Medicine, Pisa, Italy
- Department of Laboratory Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital Padova, Padova, Italy
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5
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Li L, Shu X, Zhang L, Xu A, Yang J, Jing Y, Wang H, Zhang Z. Evaluation of the analytical and clinical performance of a new high-sensitivity cardiac troponin I assay: hs-cTnI (CLIA) assay. Clin Chem Lab Med 2024; 62:353-360. [PMID: 37746851 DOI: 10.1515/cclm-2023-0529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Cardiac troponin (cTn) is the key biomarker for diagnosis of acute coronary syndrome (ACS). We performed a complete assessment of the high-sensitivity cardiac troponin I (hs-cTnI) (CLIA) assay on the analytical performance and clinical diagnostic performance, which was compared with Abbott ARCHITECT hs-cTnI assay. METHODS Sex-specific 99th percentile upper reference limits (URLs) were determined from a healthy population of 424 males and 408 females. High-sensitivity performance was assessed by examining the imprecision at sex-specific URLs and the detectable results above LoD in a cohort of healthy population. The diagnostic performance of the hs-cTnI (CLIA) assay was validated in a population of 934 patients with suspected ACS. RESULTS The 99th percentile URLs were 15.3 ng/L for female, 31.3 ng/L for male and 24.2 ng/L for overall population. The total imprecision near the sex-specific 99th percentile URLs were <5 %. 76.74 % of females, 97.12 % of males and 86.69 % of overall population had cTnI values exceeding the LoD, which met the criteria of high-sensitivity troponin assay. No cross-reactivity or interference was identified. The diagnostic sensitivity, specificity, PPV, NPV, and AUC of hs-cTnI (CLIA) assay were 97.97 , 90.70, 79.02, 99.21 % and 0.9885, respectively, which were comparable to ARCHITECT hs-cTnI assay. CONCLUSIONS hs-cTnI (CLIA) assay is a high-sensitivity troponin I method with high precision, sensitivity and specificity. The clinical diagnostic performance of hs-cTnI (CLIA) is comparable to the established ARCHITECT hs-cTnI assay. Mindray's hs-cTnI (CLIA) assay is an attractive alternative for diagnosis of myocardial infarction with a high level of accuracy and safety.
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Affiliation(s)
- Ling Li
- Clinical Laboratory of Wuhan Asia Heart Hospital, Wuhan, Hubei, P.R. China
| | - Xin Shu
- Clinical Laboratory of Wuhan Asia General Hospital, Wuhan, Hubei, P.R. China
| | - Litao Zhang
- Clinical Laboratory of Wuhan Asia General Hospital, Wuhan, Hubei, P.R. China
| | - Ao Xu
- Clinical Laboratory of Wuhan Asia Heart Hospital, Wuhan, Hubei, P.R. China
| | - Juan Yang
- Clinical Laboratory of Wuhan Asia Heart Hospital, Wuhan, Hubei, P.R. China
| | - Yisha Jing
- Clinical Laboratory of Wuhan Asia General Hospital, Wuhan, Hubei, P.R. China
| | - Hui Wang
- Clinical Laboratory of Wuhan Asia General Hospital, Wuhan, Hubei, P.R. China
| | - Zhenlu Zhang
- Clinical Laboratory of Wuhan Asia Heart Hospital, Wuhan, Hubei, P.R. China
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6
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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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7
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van Avezaath LK, Nijenhuis HP, Muller Kobold AC. Unexpected high troponin T and I values in a child with hypertrophic cardiomyopathy and acute chest pain: a case report. Eur Heart J Case Rep 2023; 7:ytad375. [PMID: 37575535 PMCID: PMC10415857 DOI: 10.1093/ehjcr/ytad375] [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: 08/04/2022] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background Elevated troponin T (cTnT) and/or troponin I (cTnI) can be ascribed to multiple causes, mostly resulting from cardiac tissue damage and in lesser numbers resulting from non-cardiac related causes. The presence of macrotroponins is easily overlooked, with potentially negative consequences. Case summary This case report presents a case study of a 12-year-old child known to have MYH7 gene-associated hypertrophic cardiomyopathy with acute chest pain combined with an unexpected high cTnT and cTnI. A cardiac cause was deemed unlikely after additional investigation, as these showed no abnormalities. After consulting a laboratory specialist, it could be concluded that the high cTnT and cTnI were a result of macrotroponin complexes, a protein complex consisting of circulating protein and endogenous autoantibodies against that protein, resulting in elevated values with misguiding and uncertain clinical significance. Discussion Awareness of the existence of macrotroponins could have prevented costly diagnostics and prolonged hospital admission with grave psychological impact, especially in children.
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Affiliation(s)
- Lisanne K van Avezaath
- Department of Pediatric Cardiology, University of Groningen, Beatrix Children Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Hessel P Nijenhuis
- Department of Pediatric Cardiology, University of Groningen, Beatrix Children Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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8
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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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9
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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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10
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McEvoy JW, Daya N, Tang O, Fang M, Ndumele CE, Coresh J, Christenson RH, Selvin E. High-sensitivity troponins and mortality in the general population. Eur Heart J 2023; 44:2595-2605. [PMID: 37264651 PMCID: PMC10361011 DOI: 10.1093/eurheartj/ehad328] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/29/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS Cardiac troponin T and I can be measured using a number of high-sensitivity (hs) assays. This study aimed to characterize correlations between four such assays and test their comparative associations with mortality. METHODS AND RESULTS Among adults without cardiovascular disease in the 1999-2004 National Health and Nutrition Examination Survey, hs-troponin T was measured using one assay (Roche) and hs-troponin I using three assays (Abbott, Siemens, and Ortho). Cox regression was used to estimate associations with all-cause and cardiovascular mortality. Pearson's correlation coefficients comparing concentrations from each assay ranged from 0.53 to 0.77. There were 2188 deaths (488 cardiovascular) among 9810 participants. Each hs-troponin assay [log-transformed, per 1 standard deviation (SD)] was independently associated with all-cause mortality: hazard ratio (HR) 1.20 [95% confidence interval (CI) 1.13-1.28] for Abbott hs-troponin I; HR 1.10 (95% CI 1.02-1.18) for Siemens hs-troponin I; HR 1.23 (95% CI 1.14-1.33) for Ortho hs-troponin I; and HR 1.31 (95% CI 1.21-1.42) for Roche hs-troponin T. Each hs-troponin assay was also independently associated with cardiovascular mortality (HR 1.44 to 1.65 per 1 SD). Associations of hs-troponin T and all-cause and cardiovascular mortality remained significant after adjusting for hs-troponin I. Furthermore, associations of hs-troponin I remained significant after mutually adjusting for hs-troponin I from the other individual assays: e.g. cardiovascular mortality HR 1.46 (95% CI 1.19-1.79) for Abbott after adjustment for the Siemens assay and HR 1.29 (95% CI 1.09-1.53) for Abbott after adjustment for the Ortho assay. CONCLUSION This study demonstrates only modest correlations between hs-troponin T and three hs-troponin I assays and that hs-troponin I assays can provide distinct risk information for mortality in the general population.
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Affiliation(s)
- John W McEvoy
- University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91-FF68, Connacht, Ireland
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Natalie Daya
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Olive Tang
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Chiadi E Ndumele
- Johns Hopkins Hospital and Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument Street, Baltimore, MD 21205, USA
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11
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Nakano K, Sugawa S, Seimiya M, Murakami S, Yasuda K, Watanabe C, Goto H, Teshima T. Frequencies of Anti-Troponin I vs Anti-Troponin T Autoantibodies and Degrees of Interference on Troponin Assays. Lab Med 2023; 54:317-323. [PMID: 36322014 DOI: 10.1093/labmed/lmac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Presence of autoantibodies against troponin I (cTnI) or T (cTnT) has been reported to interfere with troponin assays. However, the extent of the interference with the measurement has not been explored sufficiently. The aims of this study were to examine the frequencies of autoantibodies against troponin I and troponin T and how much these antibodies would affect the measurement. METHODS The study comprised 52 subjects who visited Hokkaido University Hospital with suspected ischemic heart diseases. To evaluate the presence of autoantibodies, we calculated the recoveries of cTnI or cTnT after immunoglobulin G depletion, and the distributions of peaks reactive with cTnI or cTnT by high-performance liquid chromatography were examined. RESULTS Autoantibodies against cTnI and cTnT were identified in 8 subjects (15.4%) and 1 subject (1.9%), respectively. Although the greatest difference between cTnI and cTnT was 32-fold, the distributions of cTnI-to-cTnT ratios in groups with and without anti-cTnI were not statistically different. CONCLUSION Autoantibodies against cTnI were more frequent by several fold than those against cTnT. Their presence did not significantly expand the discrepancy between cTnI and cTnT assays.
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Affiliation(s)
- Keiichi Nakano
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Medical Technology and Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan
| | | | - Masanori Seimiya
- Department of Medical Technology and Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan
| | | | - Keiko Yasuda
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Chiaki Watanabe
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Goto
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takanori Teshima
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
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12
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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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13
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Racek J, Potočová I, Rajdl D, Trefil L, Šolcová M. False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies. Biochem Med (Zagreb) 2023; 33:010802. [PMID: 36817853 PMCID: PMC9927729 DOI: 10.11613/bm.2023.010802] [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: 09/13/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Immunochemical reactions are fast, can be automated, and generally do not require pretreatment of biological material. Based on these advantages, they are widely used. On the other hand, they are susceptible to analytical interference that can lead to inaccurate results. These factors include the presence of anti-mouse antibodies, causing false positive (or sometimes false negative) results. Although the anti-mouse antibodies over many decades have been repeatedly identified to be the causative source but due to the rarity of such encounters they remain insufficiently considered. Here we show a case, a 45 year-old female who was mis-diagnosed with pregnancy due to falsely elevated human chorionic gonadotropin (hCG) due to anti-mouse antibodies. This led to the patient undergoing two ultrasound examinations and laparoscopy before the hCG was repeated on alternative assays which showed negative results, preventing the patient from methotrexate treatment. Here we describe the details of the case, outline the assay principal, supporting the finding from literature and outlining a process on how to identify such interferences in timely manner.
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Affiliation(s)
- Jaroslav Racek
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic,Corresponding author:
| | - Ivana Potočová
- Department of Gynecology and Obstetrics, Klatovska Hospital, Klatovy, Czech Republic
| | - Daniel Rajdl
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Marie Šolcová
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
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14
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Koechlin L, Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Wussler D, Mais F, Twerenbold R, Zimmermann T, Wildi K, Köppen AM, Miró Ò, Martin-Sanchez FJ, Kawecki D, Geigy N, Keller DI, Christ M, Buser A, Giménez MR, Bernasconi L, Hammerer-Lercher A, Mueller C. Diagnostic discrimination of a novel high-sensitivity cardiac troponin I assay and derivation/validation of an assay-specific 0/1h-algorithm. Am Heart J 2023; 255:58-70. [PMID: 36243111 DOI: 10.1016/j.ahj.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to assess the diagnostic utility of the Dimension EXL LOCI High-Sensitivity Troponin I (hs-cTnI-EXL) assay. METHODS This multicenter study included patients with chest discomfort presenting to the emergency department. Diagnoses were centrally and independently adjudicated by two cardiologists using all available clinical information. Adjudication was performed twice including serial measurements of high-sensitivity cardiac troponin (hs-cTn) I-Architect (primary analysis) and serial measurements of hs-cTnT-Elecsys (secondary analysis) in addition to the clinically used (hs)-cTn. The primary objective was to assess and compare the discriminatory performance of hs-cTnI-EXL, hs-cTnI-Architect and hs-cTnT-Elecsys for acute myocardial infarction (MI). Furthermore, we derived and validated a hs-cTnI-EXL-specific 0/1h-algorithm. RESULTS Adjudicated MI was the diagnosis in 204/1454 (14%) patients. The area under the receiver operating characteristics curve for hs-cTnI-EXL was 0.94 (95%CI, 0.93-0.96), and comparable to hs-cTnI-Architect (0.95; 95%CI, 0.93-0.96) and hs-cTnT-Elecsys (0.93; 95%CI, 0.91-0.95). In the derivation cohort (n = 813), optimal criteria for rule-out of MI were <9ng/L at presentation (if chest pain onset >3h) or <9ng/L and 0h-1h-change <5ng/L, and for rule-in ≥160ng/L at presentation or 0h-1h-change ≥100ng/L. In the validation cohort (n = 345), these cut-offs ruled-out 56% of patients (negative predictive value 99.5% (95%CI, 97.1-99.9), sensitivity 97.8% (95%CI, 88.7-99.6)), and ruled-in 9% (positive predictive value 83.3% (95%CI, 66.4-92.7), specificity 98.3% (95%CI, 96.1-99.3)). Secondary analyses using adjudication based on hs-cTnT measurements confirmed the findings. CONCLUSIONS The overall performance of the hs-cTnI-EXL was comparable to best-validated hs-cTnT/I assays and an assay-specific 0/1h-algorithm safely rules out and accurately rules in acute MI. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov number, NCT00470587.
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Affiliation(s)
- Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland.
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland; Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland; Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Basel, Switzerland
| | - Felix Mais
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; Emergency Department, University Hospital Zurich, Zurich, Zurich, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland; Critical Care Research Group and the University of Queensland, Brisbane, Queensland, Australia
| | - Anne Marie Köppen
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland
| | - Òscar Miró
- GREAT network, Basel, Basel, Switzerland; Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | - F Javier Martin-Sanchez
- GREAT network, Basel, Basel, Switzerland; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Madrid, Spain
| | - Damian Kawecki
- GREAT network, Basel, Basel, Switzerland; 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Silesian, Poland
| | - Nicolas Geigy
- Emergency Department, Kantonsspital Liestal, Liestal Liestal, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Zurich, Switzerland
| | - Michael Christ
- Emergency Department, Kantonsspital Luzern, Luzern, Luzern, Switzerland
| | - Andreas Buser
- Department of hematology and Blood Bank, University Hospital Basel, University of Basel, Basel, Basel Switzerland
| | - Maria Rubini Giménez
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Saxony, Germany
| | - Luca Bernasconi
- Institute of Laboratory Medicine, County Hospital Aarau, Aarau, Aarau, Switzerland
| | | | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Basel, Switzerland; GREAT network, Basel, Basel, Switzerland.
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15
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Collinson P. Macrotroponin-Analytical Anomaly or Clinical Confounder. Clin Chem 2022; 68:1229-1231. [PMID: 35929570 DOI: 10.1093/clinchem/hvac129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022]
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, UK
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16
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Lam L, Tse R, Gladding P, Kyle C. Effect of Macrotroponin in a Cohort of Community Patients with Elevated Cardiac Troponin. Clin Chem 2022; 68:1261-1271. [PMID: 35929566 DOI: 10.1093/clinchem/hvac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Macrotroponin is an important cause of discrepancy between current high-sensitivity cardiac troponin (hs-cTn) assays, however, its clinical significance is unclear. This study examined the effects of macrotroponin and repeat testing by different hs-cTnI assays in a cohort of community patients with elevated hs-cTnI. METHODS The first residual serum specimen from each patient in the community admitted to hospital with elevated hs-cTnI (Siemens hs-cTnI Centaur) was retested after immunoglobulin depletion and by 5 other hs-cTn assays. Low recovery of cTnI (<40%) following immunoglobulin depletion was considered as macrotroponin. A retrospective chart review was performed for these participants. Investigator-adjudicated diagnosis served as the reference standard. RESULTS In our cohort of community patients with elevated troponin (n = 188), participants with macrotroponin (n = 99) often had a multifactorial or indeterminate myocardial injury (56% vs 25%) and were less likely to have acute coronary syndrome (9% vs 28%). On repeat testing of cTn on other platforms, better diagnostic performance (c-statistics) for ischemic and non-ischemic cardiac causes was observed on the Beckman Access hs-cTnI (0.74; 95% confidence interval [CI] 0.67-0.81) or the Abbott hs-cTnI Architect (0.75; CI 0.68-0.82) compared to the Siemens hs-cTnI Vista (0.62; CI 0.54-0.70; P < 0.05). This could be attributed to differences in assay reactivity for macrotroponin. Interestingly, better diagnostic performance was observed in patients without macrotroponin. Although a small number of deaths occurred (n = 16), participants with macrotroponin had better overall survival. CONCLUSIONS In the low-risk setting, the presence of macrotroponin was clinically associated with multifactorial or indeterminate causes of troponin elevation.
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Affiliation(s)
- Leo Lam
- Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand.,Biochemistry, Middlemore Hospital Laboratories, Auckland, New Zealand
| | - Rexson Tse
- Forensic Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | | | - Campbell Kyle
- Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand.,Biochemistry, Labtests, Auckland, New Zealand
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17
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Ghossein J, Ghossein J, Booth RA, Kavsak P, Chamoun C. Presence of Macrotroponin for over Two Years in a Young Adult Female. CJC Open 2022; 4:1012-1014. [DOI: 10.1016/j.cjco.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
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18
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Croal B. Commentary on Macrotroponin Complex as a Cause for Cardiac Troponin Increase after COVID-19 Vaccination and Infection. Clin Chem 2022; 68:1020-1021. [PMID: 35896173 PMCID: PMC9384577 DOI: 10.1093/clinchem/hvac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Bernard Croal
- NHS Grampian-Clinical Biochemistry, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB15 6RE, United Kingdom
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19
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Bularga A, Oskoui E, Fujisawa T, Jenks S, Sutherland R, Apple FS, Hammarsten O, Mills NL. Macrotroponin Complex as a Cause for Cardiac Troponin Increase after COVID-19 Vaccination and Infection. Clin Chem 2022; 68:1015-1019. [PMID: 35896175 PMCID: PMC9384580 DOI: 10.1093/clinchem/hvac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ellen Oskoui
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sara Jenks
- Department Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rachel Sutherland
- Department of Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fred S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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20
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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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21
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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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22
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Hasselbalch RB, Kristensen JH, Jørgensen N, Strandkjær N, Alaour B, Afzal S, Marber M, Bundgaard H, Iversen KK. High incidence of discrepancies in new Siemens assay - A comparison of cardiac troponin I assays. Clin Chem Lab Med 2022; 60:921-929. [PMID: 35411761 DOI: 10.1515/cclm-2022-0034] [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: 10/12/2021] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac Troponin (cTn) is the biochemical gold standard for diagnosing myocardial infarction (MI). We compared the Siemens ADVIA Centaur high-sensitivity (hs-cTnI) assay with the Siemens Ultra assay (cTnI-U). METHODS Over 3 months cTnI-U and hs-cTnI were measured simultaneously at Herlev-Gentofte Hospital. Acute myocardial injury was diagnosed using the 4th universal definition. Disputed cases were adjudicated using clinical data. We compared diagnostic accuracy using area under the curve (AUC) of the receiver operating characteristic. Outliers in between-assay differences were defined as a factor-5 difference and ≥1 measurement >40 ng/L. Patients with outlier differences were invited for re-sampling and tested with serial dilution and heterophilic blocking tubes. RESULTS From the 18th January to the 20th April 2019, 4,369 samples on 2,658 patients were included. cTnI-U measured higher concentrations than hs-cTnI (mean 23%, -52-213%), resulting in a higher frequency of acute myocardial injury, 255 (9.6%) vs 203 (7.6%), p<0.001. This remained significant after adjudication, 212 vs 197, p<0.001. AUC for the prediction of MI for was 0.963 for cTnI-U and 0.959 for hs-cTnI, p=0.001. Outlier differences were seen in 35 (1.2%) patients, primarily with elevated hs-cTnI (n=33, 94%). On two re-samplings (median 144 and 297 days since inclusion), 16 of 20 (80%) and 11 of 11 had sustained elevation of hs-cTnI. The samples showed no signs of heterophilic antibodies. CONCLUSIONS Using hs-cTnI resulted in a subset of patients with large, discrepant elevations in concentration. These patients still had elevated hs-cTnI 6-10 months post admission but no heterophilic antibodies.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jonas Henrik Kristensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bashir Alaour
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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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: 24] [Impact Index Per Article: 12.0] [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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24
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Lam L, Hammarsten O, Kyle C. Which method to detect macrotroponin? Clin Chem Lab Med 2022; 60:68-70. [PMID: 35007413 DOI: 10.1515/cclm-2021-1330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
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
| | - Ola Hammarsten
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Campbell Kyle
- Department of Chemical Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.,Department of Biochemistry, LabTests, Auckland, New Zealand
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Moussa Y, Suthaharen C, Eisenhuth K, Devine K, Caldwell G, Tchan M, Rahman Y. Disproportionate Elevations of Cardiac Troponin in Fabry Disease: A Case Series of False Positives due to Macrotroponin. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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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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Clerico A, Zaninotto M, Aimo A, Dittadi R, Cosseddu D, Perrone M, Padoan A, Masotti S, Belloni L, Migliardi M, Fortunato A, Trenti T, Malloggi L, Cappelletti P, Galli GA, Bernardini S, Sciacovelli L, Plebani M. Use of high-sensitivity cardiac troponins in the emergency department for the early rule-in and rule-out of acute myocardial infarction without persistent ST-segment elevation (NSTEMI) in Italy. Clin Chem Lab Med 2021; 60:169-182. [PMID: 34927403 DOI: 10.1515/cclm-2021-1085] [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: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022]
Abstract
Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0 h/1 h or 0 h/2 h) to rule-in and rule-out NSTEMI. Finally, another important point is the possible differences between demographic and clinical characteristics of patients enrolled in multicenter trials compared to those routinely admitted to the Emergency Department in Italy. The Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies Società Italiana di Biochimica Clinica, Italian Society of the European Ligand Assay Society, and Società Italiana di Patolgia Clinica e Medicina di Laboratorio decided to revise the document previously published in 2013 about the management of patients with suspected NSTEMI, and to provide some suggestions for the use of these biomarkers in clinical practice, with a particular focus on the Italian setting.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy.,Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Aimo
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ruggero Dittadi
- Ospedale dell'Angelo ULSS 3 Serenissima, Laboratorio di Analisi Cliniche, Mestre, Italy
| | - Domenico Cosseddu
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Marco Perrone
- Division of Cardiology and Clinical Biochemistry, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Silvia Masotti
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lucia Belloni
- Dipartimento di Medicina di laboratorio, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | | | - Tommaso Trenti
- Azienda Ospedaliero - Universitaria Policlinico di Modena c/o Ospedale Civile di Baggiovara, Modena, Italy
| | - Lucia Malloggi
- Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa, Pisa, Italy
| | | | | | - Sergio Bernardini
- Division of Cardiology and Clinical Biochemistry, University of Rome Tor Vergata, Rome, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
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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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Nichols M, Silversides CK, Woo A, Leung F, Taher J, Zhou Q, Brinc D. A Diagnostic Dilemma from a Presentation of Shortness of Breath and Chest Pain. J Appl Lab Med 2021; 7:575-581. [PMID: 34791316 DOI: 10.1093/jalm/jfab119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/09/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A patient presented to hospital with chest pain and shortness of breath on 2 occasions 4 weeks apart. Clinical examination revealed an elevated jugular venous pressure consistent with heart failure or elevated filling pressures. METHODS The patient was investigated through various modalities including electrocardiogram (ECG), transthoracic echocardiogram, coronary angiography, MRI, cardiac catheterization, positron emission tomography, and an extensive laboratory workup. RESULTS Serial hs TnI measurements consistently revealed grossly elevated troponin I (>10 000 ng/L). In-lab investigation of increased high sensitivity troponin I (hsTnI) showed evidence of falsely increased troponin due to the presence of heterophilic antibodies. DISCUSSION This case demonstrates a complex patient presentation and the value of involving the laboratory medicine team when dealing with potentially discrepant results. This is a rare report of grossly elevated troponin due to heterophilic antibodies for high-sensitivity troponin Abbott assay.
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Affiliation(s)
- Matthew Nichols
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Candice K Silversides
- Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Anna Woo
- Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Felix Leung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Lab Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jennifer Taher
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Lab Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Qianghua Zhou
- Division of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
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Krintus M, Panteghini M. Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays. Clin Chem Lab Med 2021; 58:1773-1783. [PMID: 32134723 DOI: 10.1515/cclm-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians' role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 44 90, Fax: +48 52 585 36 03
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Lam L, Ha L, Gladding P, Tse R, Kyle C. Effect of macrotroponin on the utility of cardiac troponin I as a prognostic biomarker for long term total and cardiovascular disease mortality. Pathology 2021; 53:860-866. [PMID: 34272050 DOI: 10.1016/j.pathol.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
Macrotroponin is a complex formed between endogenous cardiac troponin autoantibodies and circulating cardiac troponin (cTn). It is a recognised cause of discrepancy between current high sensitivity troponin (hs-cTn) assays; and immunoglobulin-bound (macrotroponin) and unbound cTn can coexist in varying proportions in the acute setting. Increasingly it is considered when laboratory cTn results do not match a patient's clinical picture. However, despite the better understanding of macrotroponin as an analytical interference, its clinical significance remains unclear. The aim of this study was to determine the potential impact of macrotroponin on the use of cTn as a long-term prognostic marker. We repeated cTnI testing after polyethylene glycol (PEG) precipitation on consecutive participants (n=159) with a first elevated cTn above 0.2 μg/L during their hospital admission episode. Because this paper is looking at outcomes in years, the initial data were generated at a time when non-hs-cTn assays were in use. We divided the cohort into two groups based on an exploratory PEG recovery cut-off of <34.6% to indicate the presence of possible macrotroponin and compared the overall and cardiovascular related mortality. The median follow-up time for the overall cohort was 8.35 years (8.32-8.40 interquartile range) with no difference between the two groups. The overall median survival was 8.1 years. Our findings indicate a hazard ratio of 0.54 (0.32-0.91 95% CI) for all-cause mortality and 0.48 (0.24-0.95) for cardiovascular mortality in patients with possible macrotroponin compared to those patients with troponin elevation without evidence of macrotroponin, after adjustment for common cardiovascular disease risk factors. Furthermore, an association was observed between PEG% recovery and all-cause mortality (p<0.05). This study showed that patients with macrotroponin have comparatively favourable long-term all-cause and cardiovascular mortality in a cohort of patients with elevated troponin. We illustrate the importance of recognising cTn results as being a summation of heterogeneous components, including those bound to antibodies, and the potential role of macrotroponin to further improve our interpretation and use of cTn as a biomarker.
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Affiliation(s)
- Leo Lam
- Department of Chemical Pathology, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Middlemore Hospital Laboratories, Auckland, New Zealand
| | - Leah Ha
- Department of Chemical Pathology, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Middlemore Hospital Laboratories, Auckland, New Zealand
| | - Patrick Gladding
- Department of Cardiology, North Shore Hospital, Auckland, New Zealand
| | - Rexson Tse
- Department of Forensic Pathology, Auckland City Hospital, Auckland, New Zealand
| | - Campbell Kyle
- Department of Chemical Pathology, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Labtests, Auckland, New Zealand.
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32
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Warner JV, Lam L. Macrotroponin Probably Contributes to a Difference in Patient Stratification in Suspected Acute Coronary Syndromes. J Am Coll Cardiol 2021; 78:295-296. [PMID: 34266585 DOI: 10.1016/j.jacc.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
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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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Kavsak PA, Tandon V, Ainsworth C. A Three-Site Immunoassay for High-Sensitivity Cardiac Troponin I with Low Immunoreactivity for Macrocomplexes. Clin Chem 2021; 66:854-855. [PMID: 32395764 DOI: 10.1093/clinchem/hvaa098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2020] [Indexed: 11/14/2022]
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Favresse J, Bayart JL, Gruson D, Bernardini S, Clerico A, Perrone M. The underestimated issue of non-reproducible cardiac troponin I and T results: case series and systematic review of the literature. Clin Chem Lab Med 2021; 59:1201-1211. [PMID: 33554552 DOI: 10.1515/cclm-2020-1564] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named "fliers" or "outliers". Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28-0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.
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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
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, Cliniques Saint-Pierre, Ottignies, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc et Université Catholique de Louvain, Woluwé-Saint-Lambert, Bruxelles, Belgium
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Clinical Molecular Biology, University of Rome Tor Vergata, Rome, Italy
| | - Aldo Clerico
- CNR-Regione Toscana G. Monasterio Foundation, Heart Hospital, Massa, Italy
- Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Perrone
- Department of Cardiology, University of Rome Tor Vergata, Rome, Italy
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Perrone MA, Storti S, Salvadori S, Pecori A, Bernardini S, Romeo F, Guccione P, Clerico A. Cardiac troponins: are there any differences between T and I? J Cardiovasc Med (Hagerstown) 2021; 22:797-805. [PMID: 33399346 DOI: 10.2459/jcm.0000000000001155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most recent international guidelines recommend the measurement of cardiac troponin I (cTnI) and cardiac troponin T (cTnT) using high-sensitivity methods (hs-cTn) for the detection of myocardial injury and the differential diagnosis of acute coronary syndromes. Myocardial injury is a prerequisite for the diagnosis of acute myocardial infarction, but also a distinct entity. The 2018 Fourth Universal Definition of Myocardial Infarction states that myocardial injury is detected when at least one value above the 99th percentile upper reference limit is measured in a patient with high-sensitivity methods for cTnI or cTnT. Not infrequently, increased hs-cTnT levels are reported in patients with congenital or chronic neuromuscular diseases, while the hs-cTnI values are often in the normal range. Furthermore, some discrepancies between the results of laboratory tests for the two troponins are occasionally found in individuals apparently free of cardiac diseases, and also in patients with cardiac diseases. In this review article, authors discuss the biochemical, pathophysiological and analytical mechanisms which may cause discrepancies between hs-cTnI and hs-cTnT test results.
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Affiliation(s)
- Marco A Perrone
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS Division of Cardiology, University of Rome Tor Vergata, Rome CNR-Regione Toscana G. Monasterio Foundation, Heart Hospital, Massa, and Scuola Superiore Sant'Anna CNR Institute of Clinical Physiology, Pisa Division of Clinical Biochemistry and Clinical Molecular Biology, University of Rome Tor Vergata, Rome, Italy
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Liu S, Chan J, Brinc D, Gandhi S, Izenberg A, Delgado D, Abdel-Qadir H, Wintersperger BJ, Thavendiranathan P. Immune Checkpoint Inhibitor-Associated Myocarditis With Persistent Troponin Elevation Despite Abatacept and Prolonged Immunosuppression. JACC: CARDIOONCOLOGY 2020; 2:800-804. [PMID: 34396297 PMCID: PMC8352272 DOI: 10.1016/j.jaccao.2020.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/26/2022]
Key Words
- AchR-Ab, acetylcholine receptor antibody
- CMR, cardiovascular magnetic resonance
- HF, heart failure
- ICI, immune checkpoint inhibitor
- LGE, late gadolinium enhancement
- LVEF, left ventricular ejection fraction
- MG, myasthenia gravis
- MMF, mycophenolate mofetil
- PD-1, programmed cell death receptor-1
- PEG, polyethylene glycol
- RR, reference range
- abatacept
- cardiovascular MRI
- hsTnI, high-sensitivity troponin I
- immune check point inhibitors
- immunotherapy
- macrotroponins
- myasthenia gravis
- myocarditis
- troponin
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Affiliation(s)
- Shiying Liu
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Chan
- Department of Pharmacy, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Izenberg
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Diego Delgado
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bernd J. Wintersperger
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Address for correspondence: Dr. Paaladinesh Thavendiranathan, Ted Rogers Program in Cardiotoxicity Prevention, University Health Network, University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. @dineshpmcc1
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Lam L, Aspin L, Heron RC, Ha L, Kyle C. Discrepancy between Cardiac Troponin Assays Due to Endogenous Antibodies. Clin Chem 2020; 66:445-454. [PMID: 32031592 DOI: 10.1093/clinchem/hvz032] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/09/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite well-described analytical effects of autoantibodies against cardiac troponin (cTn) I on experimental assays, no study has systematically examined their impact on cTn assays in clinical use. We determined the effects of endogenous antibodies on 5 different cTnI assays and a cTnT assay. METHODS cTn was measured by 6 methods: Siemens hs-cTnI Centaur, Siemens hs-cTnI Vista, Abbott hs-cTnI Architect, Beckman hs-cTnI Access, Beckman cTnI Access, and Roche hs-cTnT Elecsys. Measurements were repeated on 5 assays (all except Siemens hs-cTnI Vista) following immunoglobulin depletion by incubation with protein A. Low recovery of cTnI (<40%) following immunoglobulin depletion was considered positive for macro-cTnI. Protein A findings were validated by gel filtration chromatography and polyethylene glycol precipitation. RESULTS In a sample of 223 specimens selected from a community laboratory that uses the Siemens hs-cTnI Centaur assay and from which cTn was requested, 76% of samples demonstrated increased cTnI (median, 88 ng/L; interquartile range, 62-204 ng/L). Macro-cTnI was observed in 123 (55%) of the 223 specimens. Comparisons of cTnI assays markedly improved once patients with macro-cTnI were removed. Passing-Bablok regression analysis between hs-cTnI assays demonstrated different slopes for patients with and without macro-cTnI. In patients with macro-cTnI, 89 (72%) showed no effect on the recovery of cTnT, whereas 34 (28%) had reduced recovery of cTnT. The proportion of results above the manufacturers' 99th percentile varied with the cTn assay and macro-cTnI status. CONCLUSION We suggest that the observed discrepancy between hs-cTnI assays may be attributed in part to the presence of macro-cTnI.
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Affiliation(s)
- Leo Lam
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Department of Biochemistry, Middlemore Hospital Laboratories, Auckland New Zealand
| | - Lisa Aspin
- Department of Biochemistry, Labtests, Auckland, New Zealand
| | - Robert Campbell Heron
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Leah Ha
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
- Department of Biochemistry, Middlemore Hospital Laboratories, 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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Abstract
The measurement of cardiac troponin (cTn) is recommended by all guidelines as the gold standard for the differential diagnosis of Acute Coronary Syndromes. The aim of this review is to discuss in details some key issues regarding both analytical and clinical characteristics of the high-sensitivity methods for cTn (hs-cTn), which are still considered controversial or unresolved. In particular, the major clinical concern regarding hs-cTn methods is the difficulty to differentiate the pathophysiological mechanism responsible for biomarker release from cardiomyocytes after reversible or irreversible injury, respectively. Indeed, recent experimental and clinical studies have demonstrated that different circulating forms of cTnI and cTnT can be respectively measured in plasma samples of patients with reversible or irreversible myocardial injury. Accordingly, a new generation of hs-Tn methods should be set up, based on immunometric immunoassays or chromatographic techniques, specific for circulating peptide forms more characteristics for reversible or irreversible myocardial injury. It is conceivable that this new generation of hs-cTn methods will complete the mission regarding the laboratory tests for specific cardiac biomarkers, started more than 20 years ago, which has already revolutionized the diagnosis, prognosis and management of patients with cardiac diseases.
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Lam L, Heron C, Aspin L, Ha L, Kyle CV. Change in troponin concentrations in patients with macrotroponin: An in vitro mixing study. Clin Biochem 2020; 85:43-48. [PMID: 32861681 DOI: 10.1016/j.clinbiochem.2020.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Macrotroponin is a complex formed between endogenous cardiac troponin autoantibodies (cTnAABs) and circulating cardiac troponin (cTn). The potential effect of macrotroponin on current high sensitivity cTn assays has not been fully explored but has recently been identified as a major cause of discrepancy in cTn results between assays. In this study we investigated the effects of mixing troponin (cTn) standards to specimens with and without macrotroponin. METHOD Macrotroponin was identified in specimens by a recovery of cTnI < 40% following protein A immunoglobulin depletion. Troponin standards containing cTn-IC and cTn-TIC complexes were mixed with serum samples, with (n = 20) and without (n = 10) the presence of macrotroponin. Specimens were tested for cTn before and after mixing by three commercially available high sensitivity cTn assays. Gel filtration chromatography was carried out on five specimens with macrotroponin and each fraction was analzyed by multiple cTn assays. FINDINGS Following mixing with cTn-TIC standard, all specimens with macrotroponin had a markedly reduced absolute increase in cTnI, indicating negative analytical interference due to macrotroponin. Following mixing with the cTn-IC standard, specimens with macrotroponin demonstrated highly variable changes in cTnI, suggesting significant heterogeneity in macrotroponin complex reactivity between individuals. When the ratio of change, calculated by dividing the absolute change between two cTn assays, was compared between specimens with and without macrotroponin, significant differences were observed (p < 0.001). These findings were supported by variable migration of peak cTn activity on gel filtration chromatography. CONCLUSION Macrotroponin leads to assay dependent analytical interference affecting current high sensitivity troponin I assays. Furthermore, endogenously occurring cTnAABs are conformationally specific and the analytical effects vary between assays and individuals.
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Affiliation(s)
- Leo Lam
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Middlemore Hospital Laboratory, Auckland, New Zealand
| | - Campbell Heron
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Lisa Aspin
- Department of Biochemistry, Labtests, Auckland, New Zealand
| | - Leah Ha
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Middlemore Hospital Laboratory, Auckland, New Zealand
| | - Campbell V Kyle
- Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand; Department of Biochemistry, Labtests, Auckland, New Zealand.
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Han GR, Koo HJ, Ki H, Kim MG. Paper/Soluble Polymer Hybrid-Based Lateral Flow Biosensing Platform for High-Performance Point-of-Care Testing. ACS APPLIED MATERIALS & INTERFACES 2020; 12:34564-34575. [PMID: 32666783 DOI: 10.1021/acsami.0c07893] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As a global shift continues to occur in high burden diseases toward developing countries, the importance of medical diagnostics based on point-of-care testing (POCT) is rapidly increasing. However, most diagnostic tests that meet clinical standards rely on high-end analyzers in central hospitals. Here, we report the development of a simple, low-cost, mass-producible, highly sensitive/quantitative, automated, and robust paper/soluble polymer hybrid-based lateral flow biosensing platform, paired with a smartphone-based reader, for high-performance POCT. The testing architecture incorporates a polymeric barrier that programs/automates sequential reactions via a polymer dissolving mechanism. The smartphone-based reader with simple opto-mechanical parts offers a stable framework for accurate quantification. Analytical performance of this platform was evaluated by testing human cardiac troponin I (cTnI), a preferred biomarker for the diagnosis of myocardial infarction, in serum/plasma samples. Coupled with catalytic/colorimetric gold-ion amplification, this platform produced results within 20 min with a detection limit of 0.92 pg mL-1 and a coefficient of variation <10%, which is equivalent to the performance of a high-sensitivity standard analyzer, and operated within acceptable levels stipulated by clinical guidelines. Moreover, cTnI clinical sample tests indicate a high correlation (r = 0.981) with the contemporary analyzers, demonstrating the clinical utility of this platform in high-performance POCT.
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Affiliation(s)
- Gyeo-Re Han
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Hee Joon Koo
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Hangil Ki
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
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Favresse J, Cadrobbi J, Eucher C, Laffineur K, Rosseels C, Pieters D, Elsen M, Gras J. Non-reproducible cardiac troponin results occurring with a particular reagent lot. ACTA ACUST UNITED AC 2020; 59:e9-e12. [DOI: 10.1515/cclm-2020-0562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Julie Cadrobbi
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Christine Eucher
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Kim Laffineur
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Catherine Rosseels
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Denis Pieters
- Department of Cardiology , Clinique St-Luc Bouge , Namur , Belgium
| | - Marc Elsen
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
| | - Jeremie Gras
- Department of Laboratory Medicine , Clinique St-Luc Bouge , Namur , Belgium
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Christenson RH, Duh SH, Mullins KE, LeClair MM, Grigorov IL, Peacock WF. Analytical and clinical characterization of a novel high-sensitivity cardiac troponin assay in a United States population. Clin Biochem 2020; 83:28-36. [PMID: 32485169 DOI: 10.1016/j.clinbiochem.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac troponin (cTn) is the keystone for diagnosis of acute myocardial infarction (AMI). We examined the analytical and clinical diagnostic characteristics of the ACCESS hsTnI assay in a United States (US) population. METHODS All measurements and studies were conducted using a lithium heparin matrix. Sex-specific 99th percentile upper reference limits (URLs) were determined for 1089 healthy women (54.6%) and men using non-parametric statistics. High-sensitivity (hs) performance was assessed to determine if the total CV was ≤10% at sex-specific URLs, and if ≥50% of cTnI values for each sex exceeded the assay's limit of detection (LoD). Precision, analytical measurement range, high-dose hook effect, and endogenous/exogenous interferences were examined with CLSI guidance. Clinical characterization included serial sampling of 1854 suspected AMI subjects presenting to 14 US Emergency Departments. AMI was adjudicated by a panel of expert cardiologists. The study's only exclusion was end stage renal disease. RESULTS 99th percentile URLs were 11.6-, 19.8- and 17.5-ng/L for respective female, male and all-subject populations. Total %CV was <8% from 6.8 to 19,000 ng/L, and <6% at sex-specific 99th percentiles; ≥99% of ACCESS hsTnI values for each sex exceeded the LoD. No high-dose hook effect or endogenous/exogenous interferences were identified. A comparison of Baseline samples collected at ≤1 h and any-time after presentation, found 4% lower sensitivity for AMI than with earlier sampling. For 1-9 h post presentation, the sensitivity was >90%, specificity >85%; and negative and positive predictive value were ≥99% and >60%, respectively. CONCLUSION Analytical and clinical performance of the ACCESS hsTnI assay meets the definition of a hs cTn method. The ACCESS hsTnI assay has good precision over a wide range, no significant interferences, and sensitivity >90% and NPV ≥99%. Performance is appropriate for aiding in AMI diagnosis.
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Affiliation(s)
- Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Show-Hong Duh
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Margot M LeClair
- Beckman Coulter Inc., 1000 Lake Hazeltine Dr, Chaska, MN, United States
| | - Ilya L Grigorov
- Beckman Coulter Inc., 1000 Lake Hazeltine Dr, Chaska, MN, United States
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
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44
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Boeddinghaus J, Twerenbold R, Nestelberger T, Koechlin L, Wussler D, Meier M, Troester V, Zimmermann T, Badertscher P, Wildi K, Rubini Giménez M, Lopez-Ayala P, Potlukova E, Miró Ò, Martin-Sanchez FJ, Kawecki D, Geigy N, Keller DI, Reichlin T, Mueller C. Clinical Use of a New High-Sensitivity Cardiac Troponin I Assay in Patients with Suspected Myocardial Infarction. Clin Chem 2019; 65:1426-1436. [PMID: 31570633 DOI: 10.1373/clinchem.2019.304725] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to validate the clinical performance of the high-sensitivity cardiac troponin I [VITROS® Immunodiagnostic Products hs Troponin I (hs-cTnI-VITROS)] assay. METHODS We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists considering all clinical information, including cardiac imaging: first, using serial hs-cTnT-Elecsys (primary analysis) and, second, using hs-cTnI-Architect (secondary analysis) measurements in addition to the clinically used (hs)-cTn. hs-cTnI-VITROS was measured at presentation and at 1 h in a blinded fashion. The primary objective was direct comparison of diagnostic accuracy as quantified by the area under the ROC curve (AUC) of hs-cTnI-VITROS vs hs-cTnT-Elecsys and hs-cTnI-Architect, and in a subgroup also hs-cTnI-Centaur and hs-cTnI-Access. Secondary objectives included the derivation and validation of an hs-cTnI-VITROS-0/1-h algorithm. RESULTS AMI was the adjudicated final diagnosis in 158 of 1231 (13%) patients. At presentation, the AUC for hs-cTnI-VITROS was 0.95 (95% CI, 0.93-0.96); for hs-cTnT-Elecsys, 0.94 (95% CI, 0.92-0.95); and for hs-cTnI-Architect, 0.92 (95% CI, 0.90-0.94). AUCs for hs-cTnI-Centaur and hs-cTnI-Access were 0.95 (95% CI, 0.94-0.97). Applying the derived hs-cTnI-VITROS-0/1-h algorithm (derivation cohort n = 519) to the validation cohort (n = 520), 53% of patients were ruled out [sensitivity, 100% (95% CI, 94.1-100)] and 14% of patients were ruled in [specificity, 95.6% (95% CI, 93.4-97.2)]. Patients ruled out by the 0/1-h algorithm had a survival rate of 99.8% at 30 days. Findings were confirmed in the secondary analyses using the adjudication including serial measurements of hs-cTnI-Architect. CONCLUSIONS The hs-cTnI-VITROS assay has at least comparable diagnostic accuracy with the currently best validated hs-cTnT and hs-cTnI assays. CLINICALTRIALSGOV IDENTIFIER NCT00470587.
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Affiliation(s)
- Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Mario Meier
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Valentina Troester
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network.,Division of Cardiology, University of Illinois at Chicago, Chicago, IL
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network.,Critical Care Research Group, the Prince Charles Hospital, Brisbane and the University of Queensland, Brisbane, Australia
| | - Maria Rubini Giménez
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network
| | - Eliska Potlukova
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- GREAT network.,Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | - Damian Kawecki
- GREAT network.,2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland
| | - Nicolas Geigy
- Emergency Department, Kantonsspital Liestal, Liestal, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT network.,Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; .,GREAT network
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Baroni S, Troiani E, Santonocito C, Moretti G, De Luca C, Antenucci M, Urbani A. A false positive case of high-sensitivity cardiac troponin in a patient with acute chest pain: Analytical study of the interference. Clin Biochem 2019; 66:103-105. [PMID: 30738031 DOI: 10.1016/j.clinbiochem.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 11/27/2022]
Abstract
We report a case of a heterophile antibodies interference in a new high-sensitivity troponin commercial immunoassay (cTNIH Siemens), observed in a patient with possible acute coronary syndrome (ACS). The analytical interference was investigated with standard laboratories procedures. The false positive result was found with different troponin methods and kits. We also investigated the protein sequence of cTnl and no sequence variants were detected. The discordance between clinical pictures and high concentration of cTnl, together with the collaboration between clinicians and laboratory staff avoided possible erroneous diagnosis and further invasive investigations to the patient.
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Affiliation(s)
- S Baroni
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - E Troiani
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - C Santonocito
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Moretti
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - C De Luca
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - M Antenucci
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Urbani
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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46
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Revisiting the Biological Variability of Cardiac Troponin: Implications for Clinical Practice. Clin Biochem Rev 2019; 40:201-216. [PMID: 31857741 DOI: 10.33176/aacb-19-00032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diagnosis of acute myocardial injury requires a rise and/or fall of cardiac troponin (cTn) on serial testing, with at least one concentration above the 99th percentile value of a normal reference population according to the recently published Fourth Universal Definition of Myocardial Infarction.1 However, the magnitude of change in cTn that constitutes a significant rise and/or fall was again not specified in detail. High-sensitivity cardiac troponin (hs-cTn) assays can measure ten-fold lower concentrations of cTn with more precision than older assays, and can accurately quantify cTn in more than 50% of healthy individuals with a coefficient of variation of less than 10% at the 99th percentile. These hs-cTn assays are also able to detect the normal variations in cTn results that are due to biological variability. Understanding and quantifying the normal variations in cTn is important as this would allow significant changes to be better defined. Numerous studies have sought to investigate the biological variability of cTn over the last ten years. Such studies are usually conducted in healthy individuals, however individuals with chronic cardiac disease or chronic renal failure have also been examined. These studies have yielded varying results in regards to significant change values for cTn. In light of the recent redefinition for myocardial infarction, the purpose of this mini-review is to revisit the biological variability of cTn. In particular, we outline concepts for determining a significant change value, review the results of previous studies on the biological variation of cTn and discuss potential considerations for clinical practice.
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47
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Kavsak PA, Ainsworth C, Arnold DM, Scott T, Clark L, Ivica J, Mackett K, Whitlock R, Worster A. The potential role of a turbidimetric heart-type fatty acid-binding protein assay to aid in the interpretation of persistently elevated, non-changing, cardiac troponin I concentrations. Clin Biochem 2018; 58:53-59. [DOI: 10.1016/j.clinbiochem.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 01/02/2023]
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Hickman PE, Koerbin G, Badrick T, Oakman C, Potter JM. The importance of low level QC for high sensitivity troponin assays. Clin Biochem 2018; 58:60-63. [PMID: 29750940 DOI: 10.1016/j.clinbiochem.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND With the advent of the new high-sensitivity troponin assays, it is becoming critical to measure troponin accurately to low concentrations. To ensure assay performance is acceptable, appropriate QC must be run. METHODS In addition to the routine use of commercial QC material, we prepared pools of human QC material with low troponin concentrations close to the limit of quantitation, and ran these regularly on our laboratory analysers. RESULTS Over 3 years we found no drift or shift in our hs-cTnI assay. We found that only the very low concentration human QC material gave warning of precision problems with the hs-cTnI assay. At the time of the documented poor assay precision, the higher concentration QC material indicated satisfactory performance. CONCLUSIONS Choice of QC material with an appropriate concentration is important for any assay. For hs-cTn assays, it is of particular importance to use control material with a concentration near to the limit of quantitation.
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Affiliation(s)
- Peter E Hickman
- ACT Pathology, Garran, ACT 2605, Australia; Australian National University Medical School, Canberra, ACT 200, Australia.
| | - Gus Koerbin
- Australian National University College of Medicine and Health, Canberra, ACT 0200, Australia
| | - Tony Badrick
- RCPA Quality Assurance Programs, St Leonards, Sydney, Australia
| | | | - Julia M Potter
- ACT Pathology, Garran, ACT 2605, Australia; Australian National University Medical School, Canberra, ACT 200, Australia
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Alquézar-Arbé A, Sionis A, Ordoñez-Llanos J. Cardiac troponins: 25 years on the stage and still improving their clinical value. Crit Rev Clin Lab Sci 2017; 54:551-571. [PMID: 29226754 DOI: 10.1080/10408363.2017.1410777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Twenty-five years ago, non-isotopic immunoassays for measuring the cardiac specific isoforms of troponin I (cTnI) and T (cTnT) were developed. Both biomarkers radically changed the diagnosis, prognosis, and therapy indication of acute coronary syndromes (ACS) and, particularly, of myocardial infarction (MI). However, cardiac troponins (cTn) rapidly demonstrated their usefulness in other cardiac and non-cardiac conditions, a part of the ischemic coronary diseases. Consequently, the number of patients to be tested for cTn and the number of tests requested to clinical laboratories sharply increased. Though the manufacturers continuously improved the analytical characteristics of the first cTn assays and produced different cTn assay "generations", the universal definition of myocardial infarction required less-than-available analytical imprecision at the cTn concentration used to assess MI (i.e. the 99th reference percentile). To address the clinical requirements, manufacturers developed the high-sensitivity cTn (hs-cTn) assays that allow to measure the 99th reference percentile with adequate precision, to detect cTn in many healthy subjects and, hence, to calculate the hs-cTn biological variation and especially to observe in very short time intervals serial differences in hs-cTn attributable to cardiac ischemia. Since the number of patients attending the emergency departments (ED) for a suspected ACS or MI is increasing, the improved properties of hs-cTn assays, allowing faster and safer patient assessment, will help to alleviate the sometimes overcrowded EDs. However, there are many biological, analytical, and clinical factors that can influence the true hs-cTn values of a patient. Clinicians and laboratory professionals should know about them for the best interpretation of the otherwise largely useful hs-cTn measurements. In conclusion, 25 years after their introduction for clinical use, "cTn are still on the stage and improving their clinical value".
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Affiliation(s)
| | - Alessandro Sionis
- b Cardiology Department, Acute and Intensive Cardiac Care Unit, IIB-Sant Pau, CIBER-CV , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain.,c Faculty of Medicine , Universitat de Barcelona , Barcelona , Spain
| | - Jorge Ordoñez-Llanos
- d Clinical Biochemistry Department , Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau , Barcelona , Spain.,e Biochemistry and Molecular Biology Department , Universitat Autònoma , Barcelona , Spain.,f Task Force on Clinical Application of Cardiac Biomarkers , International Federation of Clinical Chemistry , Milan , Italy
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Ward G, Simpson A, Boscato L, Hickman PE. The investigation of interferences in immunoassay. Clin Biochem 2017; 50:1306-1311. [DOI: 10.1016/j.clinbiochem.2017.08.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 01/05/2023]
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