A clinical and laboratory approach used to elucidate discordant results of high-sensitivity troponin T and troponin I

Franeková, Janka; Bláha, Martin; Bělohoubek, Jiří; Kotrbatá, Markéta; Sečník, Peter; Kubíček, Zdenĕk; Kettner, Jiří; Jabor, Antonı́n

doi:10.1016/j.cca.2015.03.046

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…In addition to a difference in clearance pathway, the presence of troponin-specific auto-antibodies and macro-troponins might have influenced detection of serum levels of both troponin isoforms in our cohort as well. Macro-troponins are rare but can result in inappropriately increased troponin levels, due to reduced serum clearance [ 35 , 36 ]. On the other hand, the release of cardiac troponins can stimulate the production of autoantibodies directed to cardiac-specific troponin, which interferes with troponin detection, and causes false-negative results [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Serum Cardiac Troponin-I is Superior to Troponin-T as a Marker for Left Ventricular Dysfunction in Clinically Stable Patients with End-Stage Renal Disease

Buiten

Bie

Rotmans³

et al. 2015

PLoS ONE

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BackgroundSerum troponin assays, widely used to detect acute cardiac ischemia, might be useful biomarkers to detect chronic cardiovascular disease (CVD). Cardiac-specific troponin-I (cTnI) and troponin-T (cTnT) generally detect myocardial necrosis equally well. In dialysis patients however, serum cTnT levels are often elevated, unlike cTnI levels. The present study aims to elucidate the associations of cTnI and cTnT with CVD in clinically stable dialysis patients.MethodsTroponin levels were measured using 5th generation hs-cTnT assays (Roche) and STAT hs-cTnI assays (Abbott) in a cohort of dialysis patients. Serum troponin levels were divided into tertiles with the lowest tertile as a reference value. Serum troponins were associated with indicators of CVD such as left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and the presence of coronary artery disease (CAD). Associations were explored using regression analysis.ResultsWe included 154 consecutive patients, 68±7 years old, 77% male, 70% hemodialysis. Median serum cTnT was 51ng/L (exceeding the 99th percentile of the healthy population in 98%) and median serum cTnI was 13ng/L (elevated in 20%). A high cTnI (T3) was significantly associated with a higher LVMI (Beta 31.60; p=0.001) and LVEF (Beta -4.78; p=0.005) after adjusting for confounders whereas a high serum cTnT was not. CAD was significantly associated with a high cTnT (OR 4.70 p=0.02) but not with a high cTnI. Unlike cTnI, cTnT was associated with residual renal function (Beta:-0.09; p=0.006).ConclusionIn the present cohort, serum cTnI levels showed a stronger association with LVMI and LVEF than cTnT. However, cTnT was significantly associated with CAD and residual renal function, unlike cTnI. Therefore, cTnI seems to be superior to cTnT as a marker of left ventricular dysfunction in asymptomatic dialysis patients, while cTnT might be better suited to detect CAD in these patients.

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Section: Discussionmentioning

confidence: 99%

Serum Cardiac Troponin-I is Superior to Troponin-T as a Marker for Left Ventricular Dysfunction in Clinically Stable Patients with End-Stage Renal Disease

Buiten

Bie

Rotmans³

et al. 2015

PLoS ONE

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“…This negative interference seems to be time dependent and can be managed by laboratories with systematic measurement of sample haemolysis. Interferences of heterophilic antibodies have also been described ( 2 ). Recently, Trambas et al described a negative interference affecting the result of troponin T by using hs-cTnT assay due to concentration of biotin above physiological value ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Biotin and high-sensitivity cardiac troponin T assay

et al. 2018

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IntroductionThe high-sensitivity cardiac troponin T assay of Roche Diagnostics is known to have interference with high concentrations of biotin as this assay uses biotin-streptavidin binding as detection method. As studies so far have not shown if different biotin concentrations could have diverse influence on various troponin concentrations and whether interference could be removed by available protocol within corresponding turnaround time we aimed to investigate it.Materials and methodsPlasma samples were spiked with different concentration of biotin solution. Troponin T concentrations were tested on a Roche Cobas® 8000 module 602 analyser. Final concentrations of biotin and troponin T were 50, 100, 500 and 1000 μg/L and 18, 59, 201 and 6423 ng/L, respectively. Impact of different incubation times following biotin neutralization protocol described by Piketty et al. was also tested.ResultsWe observed a mean of negative biases of 24, 56, 97, and 98% of the troponin T expected value at biotin concentrations of 50, 100, 500, 1000 μg/L. Neutralization protocol was applied on the sample with initial concentration of TnT of 59 ng/L at a biotin concentration of 1000 μg/L. Same results across different incubation times from 60 to 0 minutes were obtained (mean value 56.8 ng/L, coefficient of variation of 1.31%). We demonstrated that neutralization process had a dilution effect of the troponin concentration (loss of 4.5% to 9.6% of initial troponin value).ConclusionsBiotin interference is not dependent of initial troponin value. Interference could be successfully neutralized within a time frame compatible with emergency but results still should be carefully interpreted due to possible dilution effect.

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“…[ 2 ] In addition, false-positive test results are known with immunoassays secondary to the presence of heterophilic antibodies or human autoantibodies even though most assays contain blocking antibodies to avoid these interferences. [ 5 6 ]…”

Section: Nonacute Coronary Syndrome Causes Of Increased High-sensitivmentioning

confidence: 99%

Clinical significance of elevated high-sensitivity troponin T in low likelihood acute coronary syndrome patients

2018

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High-sensitivity cardiac troponin T (hs-cTnT) is widely used in Oman and other Gulf countries. The availability of newer generation hs-cTnT has increased the sensitivity of diagnosing non-ST-elevation acute coronary syndrome (ACS). They utilize same antibodies as fourth-generation assay but can measure 10-fold lower levels of cTnT. Any detectable level above the 99th percentile of population suggests myocardial damage. However, the cause could be non-ACS. Therefore, the increase in sensitivity of hs-cTnT assays for ACS comes at the cost of a reduced ACS specificity because more patients with other causes of myocardial injury are detected than with previous cTnT assays. Hence, there is large confusion among emergency physicians regarding optimal cutoff values to definitely confirm non-ST-elevation ACS, especially in patients with low likelihood of ACS. This review summarizes the available clinical and biochemical data to make recommendations about hs-cTnT cutoff values which will guide physicians to take decision in patients presenting with low likelihood ACS.

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A clinical and laboratory approach used to elucidate discordant results of high-sensitivity troponin T and troponin I

Cited by 10 publications

References 14 publications

Serum Cardiac Troponin-I is Superior to Troponin-T as a Marker for Left Ventricular Dysfunction in Clinically Stable Patients with End-Stage Renal Disease

Serum Cardiac Troponin-I is Superior to Troponin-T as a Marker for Left Ventricular Dysfunction in Clinically Stable Patients with End-Stage Renal Disease

Biotin and high-sensitivity cardiac troponin T assay

Clinical significance of elevated high-sensitivity troponin T in low likelihood acute coronary syndrome patients

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