Enhancing the Diagnostic Performance of Troponins in the Acute Care Setting

“Real life use” of troponin in the emergency department: a survey of over 3000 cases

“…Moreover, as previously described, significantly higher median cTnI level was also observed in patients with infections ( 14 ). A large number of patients with other conditions displayed cTnI positivity, and this evidence is attributable to the fact that the patient population presenting to the ED is different from the normal population used to establish the diagnostics specification of cTnI ( 15 ), wherein an increased rate of cTnI positivity may be caused by minimal myocardial injury that is typically lacking in the reference population. In our study population (median age 72 years), a relative 5% increased risk of positivity to cTnI was observed for any one-unit age increase.…”

High-Sensitive Troponin Testing and the “Runner's Syndrome”

“…Cardiac troponins are present in the myocyte in high concentrations, in both a cytosolic and structurally bound protein pool. Taken together, these data reflect the two faces of a coin, where remarkable advances in diagnostic technology are introducing new and powerful hs assays capable of detecting the lowest measurable troponin level in blood that reflects minor and often clinically negligible signs of myocardial injury, whereas clinicians ask for higher cutoffs derived from a reference population of patients at low risk for MI to improve the clinical performance of troponin testing in the setting of myocardial ischemia (15). In fact, because it is unlikely that plasma increments after physical exercise always reflect a clinically threatening myocardial injury, a different pathophysiological process might be at work, involving increased cellular permeability and early troponin release ("leakage") from the cytosolic pool or from a different readily accessible cell pool into the bloodstream (11,12).…”

Evaluation of Optical Detection Platforms for Multiplexed Detection of Proteins and the Need for Point-of-Care Biosensors for Clinical Use

“…In fact, c Tnl is such a strong biomarker to aid in diagnosis and treatment of myocardial infarction that current medical guidelines state that results of c TNL must be available to clinicians within 60 min after drawing the patient's blood [ 143 ]. However, use of these three biomarkers may be helpful in identifying patients with acute coronary syndrome who may be discharged from the hospital within 2 h [ 153 ] and use of CK-MB may help diagnose and treat myocardial infarction [ 154 ]. Since early diagnosis of myocardial infarction and other cardiac diseases can have a great impact on a patient's outcome, use of a POC sensor containing either simply c Tnl or c Tnl in conjunction with myoglobin and CK-MG would be very useful for different circumstances when adopted by hospitals around the world for use on a routine basis.…”