Biochemia Medica, Vol. 28 No. 3, 2018.
Review article
https://doi.org/10.11613/BM.2018.030501
“Ultra-sensitive” cardiac troponins: Requirements for effective implementation in clinical practice
Giuseppe Lippi
orcid.org/0000-0001-9523-9054
; 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
Abstract
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.
Keywords
cardiac troponin; myocardial infarction; acute coronary syndrome; diagnostics
Hrčak ID:
206651
URI
Publication date:
15.10.2018.
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