Reference range values of troponin measured by sensitive assays in elderly patients without any cardiac signs/symptoms

Menacer, Samia; Claessens, Yann-Érick; Meune, Christophe; Elfassi, Yaelle; Wakim, Céline; Gauthier, L.; Fortun, Mickaël; Goudot, François‐Xavier; Dehoux, Monique; Lefèvre, Guillaume; Chenevier‐Gobeaux, Camille

doi:10.1016/j.cca.2012.11.031

Cited by 15 publications

(11 citation statements)

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“…This in accordance with the findings of Hammarsten et al [12] who found highly age-dependent cTnT percentiles above a breaking point of around 65 years in ED patients without conditions that increase cTnT. In accordance with our results, several authors have suggested that a higher decision limit must be considered for patients older than 65–70 years [12, 20, 21]. In our study, male sex was at the limit of significance (Table 3).…”

Section: Discussionsupporting

confidence: 93%

“…This has also been found in one study of ED patients older than 65 years [12]. However, some recent studies have failed to show gender differences at ages above 75 years [20, 21]. We also found that NT-proBNP above a level in accordance with heart failure had a strong correlation to a cTnT level of ≥15 ng/L, whereas the clinical diagnosis of heart failure had not.…”

Section: Discussionsupporting

confidence: 86%

“…This can be compared with the fact that ED patients, at least 75 years old and without conditions that increase cTnT, have been shown to have cTnT levels above the 99th percentile in 43–48% of cases [20, 21]. In one-third of these cases, cTnT levels had normalized after almost 3 years.…”

Section: Discussionmentioning

confidence: 99%

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Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study

et al. 2015

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BackgroundThere is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test.MethodsThis study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7 days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30 days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T ≥ 15 ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T ≥ 15 ng/L and no signs of AMI or UA were followed up for 2–3 years.ResultsThree patients were diagnosed with AMI and three with UA. At the ≥ 15 ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50 ng/L. Troponin T ≥ 15 ng/L was correlated to age ≥65 years (odds ratio (OR), 10.9 95% CI 2.28–51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61–46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2–3 years.ConclusionsA high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65 years. For patients older than 65–70 years, a higher decision limit than ≥15 ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 86%

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Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study

et al. 2015

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“…European academic society taskforces have singled out this point as one of the critical issues surrounding hs-cTn assays [5]. Age, sex and renal function can all influence the 99th percentile [9,12,13].…”

Section: Hs-ctn and MImentioning

confidence: 99%

“…and 'Does the level of hs-cTn elevation point to aetiology? '): root causes of type 2 MI, such as anaemia, tachyarrhythmia/bradyarrhythmia, hypotension/hypertension, hypoxia [6]; multifactorial or indeterminate causes (acute neurological injury, heart failure, catecholamine-induced cardiomyopathy and others) [6]; chronic causes, for which the cut-off limit in new-generation hs-cTn assays is above the URL of a 'healthy adult' reference population, such as advanced age, heart failure, prior history of coronary heart disease or renal failure [6,13,23].…”

Section: Are There Other Decision Cut-offs?mentioning

confidence: 99%

High-sensitivity cardiac troponin assays: Answers to frequently asked questions

Chenevier‐Gobeaux¹,

Bonnefoy‐Cudraz²,

Charpentier³

et al. 2015

Archives of Cardiovascular Diseases

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Cardiac troponin (cTn) assays have quickly gained in analytical sensitivity to become what are termed 'high-sensitivity cardiac troponin' (hs-cTn) assays, bringing a flurry of dense yet incomplete literature data. The net result is that cTn assays are not yet standardized and there are still no consensus-built data on how to use and interpret cTn assay results. To address these issues, the authors take cues and clues from multiple disciplines to bring responses to frequently asked questions. In brief, the effective use of hs-cTn hinges on knowing: specific assay characteristics, particularly precision at the 99th percentile of a reference population; factors of variation at the 99th percentile value; and the high-individuality of hs-cTn assays, for which the notion of individual kinetics is more informative than straight reference to 'normal' values. The significance of patterns of change between two assay measurements has not yet been documented for every hs-cTn assay. Clinicians need to work hand-in-hand with medical biologists to better understand how to use hs-cTn assays in routine practice.

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