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

Kavsak, Peter A.; Ainsworth, Craig; Arnold, Donald M.; Scott, Terry; Clark, Lorna; Ivica, Josko; Mackett, Katharine; Whitlock, Richard; Worster, Andrew

doi:10.1016/j.clinbiochem.2018.05.006

Cited by 13 publications

(6 citation statements)

References 42 publications

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“…Discrepant results > 2x URL on the Abbott hs-cTnI Architect have also been used to indicate specimens potentially affected by macrotroponin. 13 This approach is highly specific, similar to PEG precipitation, when certain assay combinations are used. Although discrepancies between troponin assays have been used to detect macrotroponin, direct and systematic evidence for this practice has not been evaluated.…”

Section: Discussionmentioning

confidence: 99%

Practical approaches to the detection of macrotroponin

Lam

Kyle

2023

Ann Clin Biochem

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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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Section: Discussionmentioning

confidence: 99%

Practical approaches to the detection of macrotroponin

Lam

Kyle

2023

Ann Clin Biochem

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“…Some approaches to address potentially analytical false-positive troponin results have been suggested. 3 , 4 , 5 , 6 At minimum, clinicians should contact the laboratory medical (or technical) staff to initiate an investigation when troponin results are not consistent with the clinical picture. Investigations can include testing by an alternate method (ie, cTnI and/or cTnT) and by different methodologies, additional biomarkers with some cardio-specificity (eg, CK-MB isoform, heart-type fatty-acid binding protein, CK), use of human anti-mouse antibodies blocking agents in the case of human anti-mouse antibody interference, and post-polyethylene glycol precipitation when macrotroponin is suspected.…”

Section: Discussionmentioning

confidence: 99%

“…There are some published approaches to address potentially analytical false-positive troponin results [3][4][5][6] . At minimum, clinicians should contact the laboratory medical (or technical) staff to initiate an investigation when troponin results are not consistent with the clinical picture.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Presence of Macrotroponin for Over 2 Years in a Young Woman

Ghossein

Booth

et al. 2022

CJC Open

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“…Although the measurement of additional acute cardiac biomarkers provides limited information in patients with possible ACS, 68 recent evidence has suggested that hearttype fatty acid-binding protein (H-FABP), an early marker of myocardial ischemia, might be useful for stratifying the risk of cardiac injury across many different clinical settings, 69 and possibly in patients with acute PE. Of note, a study published by Dellas and colleagues showed that the so-called FAST prognostic score (including H-FABP, syncope, and tachycardia) yielded a higher diagnostic performance (c-index, 0.86) as compared with the 2014 ESC model (c-index, 0.62) and the sPESI score (c-index, 0.68).…”

Section: Discussionmentioning

confidence: 99%

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

Lippi

Favaloro

Kavsak

2019

Semin Thromb Hemost

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The ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.

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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

Cited by 13 publications

References 42 publications

Practical approaches to the detection of macrotroponin

Practical approaches to the detection of macrotroponin

Presence of Macrotroponin for Over 2 Years in a Young Woman

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

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