False Positive Troponin I Rendering Two Admissions for “Recurrent Acute Myopericarditis”

Marinheiro, Rita; Amador, Pedro; Parreira, Leonor; Rato, Quitéria; Caria, Rui

doi:10.2174/1874192401812010055

Cited by 16 publications

(18 citation statements)

References 13 publications

(15 reference statements)

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“…At the current stage of development of high-sensitivity assays, LoD can be only a few ng/L and even <1 ng/L, which is hundreds of times more sensitive and allows detecting myocardial damage almost at the level of single cells, and the percentage of healthy people with measurable hs-TnT and hs-TnI values ranges from 50% to 100%. 17 , 40 For instance, Garcia-Osuna et al have recently studied the analytical characteristics of a new method detecting hs-TnI at the level of single molecules. The study showed that this method has about 10 times higher sensitivity than other hs-TnI methods currently in use.…”

Section: Some New Data On Troponin Biochemistry and Diagnostic Capabilities Of High-sensitivity Troponin Assaysmentioning

confidence: 99%

“…Some of the results of clinical studies and descriptions of clinical cases are striking examples of the above. 35,[37][38][39][40] Since many patients with atrial fibrillation and supraventricular tachycardia (SVT) develop symptoms of chest pain, and the electrocardiographic picture and dynamics of the increase in the concentration of cTnI and cTnT are also similar to the dynamics of cardiac troponin levels in AMI, such patients are often mistakenly diagnosed with AMI and prescribed inappropriate treatment with antiplatelet and thrombolytic drugs. Xue et al describe 2 cases in which patients with SVT were misdiagnosed with AMI.…”

Section: Cardiac-specific Troponins (Ctni and Ctnt) As Laboratory Biomarkers Of Myocardial Injury: Practical Application Possibilitiesmentioning

confidence: 99%

“… 38 More information on the prevalence, mechanisms, as well as problems and difficulties of differential diagnosis in various pathological conditions, including acute aortic dissection, pulmonary embolism, sepsis, CRF and a number of others is summarized in a review by Long et al 35 Misinterpretation of elevated cardiac troponin levels in some conditions may, for example, result in prescription of anticoagulant or antiplatelet therapy in patients with acute aortic dissection and lead to disastrous consequences for such patients. Several studies have also described erroneous diagnoses of AMI due to false-positive causes of the increase, in particular, under the influence of heterophilic antibodies 39 and alkaline phosphatase 40 …”

Section: Introductionmentioning

confidence: 99%

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Cardiac Troponins: Contemporary Biological Data and New Methods of Determination

Chaulin¹

2021

VHRM

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Laboratory diagnosis plays one of the key roles in the diagnosis of many diseases, including cardiovascular diseases (CVD). The methods underlying the in vitro study of many CVD biomarkers, including cardiac troponins (cTnI and cTnT), are imperfect and are continually being improved to enhance their analytical performance, with sensitivity and specificity being the most important. Recently developed improved cTnI and cTnT detection methods, referred to as highly sensitive methods (hs-cTnI, hs-cTnT), have changed many of our ideas about the biology of cardiac troponins and opened up a number of additional diagnostic capabilities for practical healthcare. This article systematizes some relevant data on the biology of cardiac troponins as well as on methods for determining cTnI and cTnT with an analysis of the diagnostic value of their analytical characteristics (limit of blank, limit of detection, 99th percentile, coefficient of variation, and others). Data on extracardiac expression of cTnI and cTnT, mechanisms of formation and potential clinical significance of gender, age, and circadian characteristics of hs-cTnI and hs-cTnT content in serum are discussed. Considerable attention is paid to the discussion of new diagnostic capabilities of hs-cTnI, hs-cTnT, including consideration of promising possibilities for their study in biological fluids that can be obtained by non-invasive methods. Also, some possibilities of using hs-cTnI and hs-cTnT as prognostic laboratory biomarkers in healthy people (for example, to assess the risk of developing CVD) and in patients suffering from a number of pathological conditions that cause damage to cardiomyocytes are examined, and the potential mechanisms underlying the increase in hs-cTnI and hs-cTnT are discussed.

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Section: Some New Data On Troponin Biochemistry and Diagnostic Capabilities Of High-sensitivity Troponin Assaysmentioning

confidence: 99%

Section: Cardiac-specific Troponins (Ctni and Ctnt) As Laboratory Biomarkers Of Myocardial Injury: Practical Application Possibilitiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac Troponins: Contemporary Biological Data and New Methods of Determination

Chaulin¹

2021

VHRM

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“…However, it is important to take into account that the interference susceptibility might vary among the different measurement systems ( e.g. even among various hs-TnI assays) ( 5 ).…”

Section: Laboratory Analysesmentioning

confidence: 99%

Description of interference in the measurement of troponin T by a high-sensitivity method

Aliste-Fernández

Solé-Enrech

Cano-Corres

et al. 2019

Biochem. med. (Online)

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Introduction: Measurement of high-sensitivity troponin T (hs-TnT) has become an essential step in the diagnosis of acute myocardial infarction. This high-sensitivity method allows quantifying the concentration of troponin T in blood of healthy subjects with a lower inaccuracy compared to previous reagent generations. However, the presence of certain compounds in the sample may interfere with the result. We present a patient who had repeatedly high concentrations of hs-TnT in the serum sample that did not agreed with the signs and symptoms. In addition, ultrasensitive troponin I concentration was undetectable. Materials and methods: To investigate the presence of an interfering compound, different analysis were carried out. In order to discard macro complexes in the sample, the serum was precipitated with polyethylene glycol. In addition, the serum was incubated with Scantibodies Heterophilic Blocking Tube, which can block heterophilic antibodies. Finally, a size exclusion chromatography of the sample was performed by the manufacturer. What happened: The interfering substance was allocated into fractions with proteins of 150kDa, corresponding to high molecular weight proteins like immunoglobulin G (IgG). This compound was responsible for the falsely elevated hs-TnT results and it affected only the high-sensitivity methods. Main lesson: The detected interfering compound was probably an IgG. This type of interference must be kept in mind in front of discordant results, even if they are extremely rare. Therefore, interdisciplinary cooperation between clinicians, laboratory and manufacturer is essential.

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“…Immunoassay interference due to increased endogenous ALP activity has previously been described and can cause false positive results in some ALP-containing assays [3,4]. Similarly, exogenous ALP has also been shown to cause immunoassay interference [5].…”

Section: Introductionmentioning

confidence: 99%

Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies

Maharjan

Wyness

Ray

et al. 2019

Practical Laboratory Medicine

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ObjectivesCompetitive immunoenyzmatic assays for estradiol (E2) and unconjugated estriol (uE3) on UniCel DxI 800 Access immunoassay systems (Beckman Coulter) utilize bovine alkaline phosphatase (ALP) for amplification. In these assays, rare ‘IND’ error flags indicate that a relative light unit (RLU) raw result is past the high or low end of the calibration curve but cannot be differentiated from an instrument error or analytical interference. The present studies were conducted to establish a protocol to identify analytical interference and to characterize its mechanism when present.Design and methodsMatrix and recovery studies were conducted to establish a protocol for interference identification. Spiking experiments with inactivated calf intestinal ALP were performed to determine whether interference could be blocked. Commercial anti-ALP antibodies (Abs) were spiked into human serum to model assay interference. Three E2 immunoassays which do not include ALP as a reagent component (cobas e602, Roche; Centaur XP, Siemens; ARCHITECT i2000SR, Abbott) were tested for comparative purposes.Results1:2 dilution of specimen into Access Sample Diluent A (Beckman) differentiated IND error flags due to true low results (e.g. less than the analytical measurement range; AMR) from those due to assay interference. Interferences were reduced by pre-incubation with inactivated ALP and could be replicated by spiking with commercial anti-ALP Abs.ConclusionsPatient anti-bovine ALP Abs can cause interference on DxI 800 E2 and uE3 assays. This model can be used to investigate interference risk with other ALP-dependent assays.

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False Positive Troponin I Rendering Two Admissions for “Recurrent Acute Myopericarditis”

Cited by 16 publications

References 13 publications

Cardiac Troponins: Contemporary Biological Data and New Methods of Determination

Cardiac Troponins: Contemporary Biological Data and New Methods of Determination

Description of interference in the measurement of troponin T by a high-sensitivity method

Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies

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