A Rational Adoption of the High Sensitive Assay for Cardiac Troponin I in Diagnostic Routine

Abstract

We describe the adoption of high sensitive troponin I (hsTnI) in clinical practice in two hospital settings in Italy. Samples from 426 consecutive patients (mean age 68.8 ± 17.0) admitted to the Emergency Department with a suspected acute coronary syndrome (ACS) have been tested at admittance and after 3 and 6 hours by contemporary TnI and hsTnI. Results have been compared to the final clinical diagnosis. Troponin was detectable in 68.6% by TnI and 89.9% by hsTnI. Since hsTnI has a lower threshold for females, 38/41 patients with positive values only by hsTnI were women. The correlation between the assays was very high (r = 0.92). A diagnosis of acute myocardial infarction (AMI) was made in 45 cases (10.5%). The negative and positive predictive values for a 50% troponin variation at 3 hours were 95.8% and 66.7% for hsTnI and 95.0% and 52.6% for TnI and at 6 hours 90.3% and 100% for hsTnI and 88.9% and 78.9% for TnI, respectively. Receiver operating characteristic (ROC) curve analysis demonstrated a greater efficiency by hsTnI at 3 hours versus 6 hours (AUC = 0.91 versus 0.72). The main benefits of hsTnI are the adoption of gender-specific 99th percentile and the shortening of time to decision.

Usefulness of Serum Cardiac Biomarkers for Predicting In-Hospital Cardiac Complications in Acute Hip Fracture: A Prospective Cohort in 20 High Surgical Risk patients with Age over 55 Years

“…NT-proBNP and hsTnI were measured by electrochemiluminescence immunoassay on a Dimension Vista 500 (Siemens Healthcare Diagnostics, Deerfield, Illinois, US). The normal value of hsTnI was defined as less than 34.2 ng/mL in males and 15.6 ng/mL in females [ 16 ]. The same postoperative protocol was applied to all patients, with early ambulation as soon as possible.…”

Valor Prognóstico de Níveis Elevados de Troponina I Isolados em Pacientes sem Síndrome Coronariana Aguda Admitidos no Serviço de Emergência

“…Após a lesão miocárdica, a troponina citosólica é liberada primeiro; à medida que mais danos ocorrem, a troponina presente no sarcômero é liberada na circulação; 8 estudos anteriores defenderam a ideia de que cardiomiócitos com lesão reversível poderiam liberar troponina. [29][30][31] A CK-MB também é liberada com necrose tecidual devido ao seu alto peso molecular (86kDa). A mioglobina tem liberação rápida, provavelmente pelo baixo peso molecular (17kDa) e sua localização citoplasmática, podendo ser liberada sob estresse miocárdico sem necrose, 8 assim como a troponina.…”