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“Ultra-sensitive” cardiac troponins: Requirements for effective implementation in clinical practice

Giuseppe Lippi orcid id ; Section of Clinical Biochemistry, University of Verona, Verona, Italy
Fabian Sanchis-Gomar ; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain

Puni tekst: engleski pdf 185 Kb

str. 382-388

preuzimanja: 209



The measurement of cardiac troponins, either cardiac troponin I or T, has become the culprit of clinical decision making in patients with suspected
acute coronary syndrome (ACS), especially in those with non-ST elevation myocardial infarction (NSTEMI). The leading analytical mainstays of cardiac
troponin immunoassays include the limit of blank (LoB), limit of detection (LoD), functional sensitivity, the 99th percentile of a healthy reference
population, along with the percentage of “ostensibly healthy” subjects displaying measurable values < 99th percentile. The latest generation of
cardiac troponin immunoassays, conventionally defined as “high-sensitive” (HS), is characterized by a LoD over 100-fold lower compared to the first
commercialized techniques and a percentage of measurable values consistently > 50% in the general healthy population. The very recent commercialization
of methods with further improved analytical sensitivity (i.e., “ultra-sensitive” assays), which allow to measure cardiac troponin values in
the vast majority of healthy subjects, is now challenging the diagnostic paradigm based on early rule-out of subjects with cardiac troponin values
comprised between the 99th percentile and LoD. New diagnostic strategies, entailing assay-specific cut-offs, must hence be developed and validated
in large multicenter studies. The aim of this article is to provide an update on commercially available HS and “ultra”-sensitive techniques for measuring
cardiac troponins, along with possible implications of increasingly enhanced analytical sensitivity on diagnostic algorithms for evaluating
patients with suspected ACS.

Ključne riječi

cardiac troponin, myocardial infarction, acute coronary syndrome, diagnostics

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