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Clinical Benefits of the Cardiac Troponin T-high Sensitive Assay in Acute Coronary Syndrome
European Cardiology, 2011;7(1):14-17
Abstract
On 31 August 2010 Roche Diagnostics hosted a satellite symposium at the European Society of Cardiology Congress in Stockholm entitled ‘Clinical Benefits of the Cardiac Troponin T-high Sensitive Test in Acute Coronary Syndrome.’ The symposium was chaired by Hugo Katus, Medical Director of Cardiology at the Angiology and Pneumology Medical Clinic in Heidelberg and Allan Jaffe, Chair of the Division of Core Clinical Laboratory Services at the Department of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester. The symposium consisted of three talks by leaders in the field of cardiac biomarkers addressing the latest improvements in the diagnosis of acute coronary syndrome.Speakers: Christian Mueller, University Hospital Basel; Evangelos Giannitsis, Angiology and Pneumology Medical Clinic, Heidelberg; James L Januzzi, Harvard Medical School.
Support: The publication of this satellite symposium report was sponsored by Roche Diagnostics.
Keywords
Troponin T, acute coronary syndrome, biomarker, myocardial infarction, sensitivity, immunoassay
Troponin T, acute coronary syndrome, biomarker, myocardial infarction, sensitivity, immunoassay
Received:
December 03, 2010 |
Accepted
December 17, 2010 |
Citation
European Cardiology, 2011;7(1):14-17
Improvements in the Early Diagnosis of Acute Myocardial Infarction using a Cardiac Troponin T-high Sensitive Assay
In the first talk, Christian Mueller, a Professor at the University Hospital in Basel, discussed the unmet needs of current troponin assays and the improvements made in the early diagnosis of acute myocardial infarction (AMI) using the latest cardiac troponin T-high sensitive (cTnT-hs) assay.
There is a Clinical Need for High Sensitive Cardiac Troponin Tests
To put the new assay into context, Professor Mueller first explained the clinical problem in using conventional cardiac troponin (cTn) as a marker indicative of AMI. When patients report chest pain, three important variables are used to make the diagnosis: detailed patient history, 12-lead electrocardiogram (ECG) and cTn as a preferred biomarker to document myocardial cell necrosis. If the ECG shows significant ST-segment elevation, the management of the patient is clearly defined. However, for the vast majority of patients with AMI who do not have significant ST-segment elevation or depression, the cTn assay is the most important diagnostic test.
The limitation of conventional cTn assays is that it takes approximately three to four hours before a detectable increase in peripheral blood cTn levels can be detected (see Figure 1). In current clinical practice, a second cTnT test is therefore required six to eight hours after the onset of a suspected AMI and patients require constant ECG monitoring during those hours. Furthermore, the inability to make a confirmed diagnosis of AMI for up to six to eight hours after the onset of chest pain means that there is a delay in adequate therapy for those patients who are later confirmed or ‘ruled-in’ to have AMI, allowing more cardiac damage to occur and subsequently increasing the risk of morbidity. The need for monitoring and further tests also contributes to the overcrowding of emergency departments and increases overall costs. Moreover, patients with benign disease who are later excluded or ‘ruled-out’ from having AMI, suffer increased anxiety while awaiting results.
The Cardiac Troponin T-high Sensitive Assay is Superior to Conventional Tests
The conventional cTnT assay is not able to detect low concentrations of cTnT <0.01μg/l and lacks of precision until cTnT levels reach 0.035μg/l (see Figure 2). Furthermore, conventional cTn assays do not detect cTn in healthy volunteers. Thus, it has been difficult to establish the normal range of cTn.
References:
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- Apple FS, Smith SW, Pearce LA, et al., Use of the Centaur TnI-Ultra assay for detection of myocardial infarction and adverse events in patients presenting with symptoms suggestive of acute coronary syndrome, Clin Chem, 2008;54:723–8.
- Thygesen K, Alpert JS, White HD, Universal definition of myocardial infarction, Eur Heart J, 2007;28:2525–38.
- Giannitsis E, Becker M, Kurz K, et al., High-sensitivity cardiac troponin T for early prediction of evolving non-ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission, Clin Chem, 2010;56:642–50.
- Wu AH, Lu QA, Todd J, et al., Short- and long-term biological variation in cardiac troponin I measured with a high-sensitivity assay: implications for clinical practice, Clin Chem, 2009;55:52–8.
- Januzzi JL Jr, Bamberg F, Lee H, et al., High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography, Circulation, 2010;121:1227–34.
