High-sensitivity troponin assays: development and utility in a modern health-care system

Fitzgerald, G; Kerley, Robert N.; Kiernan, Thomas J.

doi:10.1080/14779072.2019.1675514

Cited by 12 publications

(21 citation statements)

References 73 publications

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“…Thus, a diagnostic method using the relative change in cTn might be affected by the baseline cTn value, which would negatively impact the AMI diagnostic performance. Moreover, detecting cTn at very low values and the use of relative change also dramatically increases the false-positive rate and leads to a potentially large increase in invasive testing and diagnosis of myocardial infarction [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department

Kim

Yun

et al. 2020

Ann Lab Med

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Background A rise and/or fall in cardiac troponin value with at least one value above the 99th percentile upper reference limit is essential for acute myocardial infarction (AMI) diagnosis. We evaluated the clinical usefulness of serial high-sensitivity cardiac troponin I (hs-cTnI) measurements in AMI diagnosis, in terms of the predictability of absolute and relative changes. Methods For this retrospective, forward observational study, we enrolled 281 patients older than 18 years who presented with chest pain at the emergency department (ED) between August 2015 and December 2016. The patients were grouped as AMI and non-AMI, and 73 (26%) were diagnosed as having AMI. Hs-cTnI (Abbott Diagnostics, Abbott Park, IL, USA) was measured at presentation and 3 hours later. We assessed the diagnostic performance of the absolute and relative changes in hs-cTnI. Results The cut-off values to predict AMI were 16.2 ng/L and 42.1% for the absolute and relative hs-cTnI changes, respectively. The area under the curve of hs-cTnI for AMI diagnosis was larger for absolute changes than for relative changes [0.96 (95% confidence interval [CI], 0.92–0.98) vs 0.89 (95% CI, 0.85–0.93)] ( P =0.014). Conclusions The absolute hs-cTnI change at 3 hours after presentation was superior to the relative change, and a rise and/or fall in hs-cTnI of >16.2 ng/L at 3 hours after presentation was useful to identify AMI in patients presenting at the ED.

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Section: Discussionmentioning

confidence: 99%

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department

Kim

Yun

et al. 2020

Ann Lab Med

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“…Considering that the development of antibody-relying hs-cTnI assays demanded decades, it is expected that the application of detection methods of higher sensitivity and assay optimization will make a similar detection range achievable by using spiegelmers [ 23 ]. In view of the presented results and the advantageous chemical characteristics of spiegelmers, these nuclease resistant oligonucleotides should be considered as plausible receptors of diagnostic devices.…”

Section: Discussionmentioning

confidence: 99%

Spiegelmer-Based Sandwich Assay for Cardiac Troponin I Detection

Tolnai

András

Szeitner

et al. 2020

IJMS

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Two subunits of the ternary troponin complex, I and C, have cardiac muscle specific isoforms, and hence could be applied as highly-selective markers of acute coronary syndrome. We aimed at paving the way for the development of a robust cardiac troponin I-detecting sandwich assay by replacing antibodies with nuclease resistant aptamer analogues, so-called spiegelmers. To complement the previously generated spiegelmers that were specific for the N-terminus of cTnI, spiegelmers were selected for an amino acid stretch in the proximity of the C-terminal part of the protein by using a D-amino acid composed peptide. Following the selection, the oligonucleotides were screened by filter binding assay, and surface plasmon resonance analysis of the most auspicious candidates demonstrated that this approach could provide spiegelmers with subnanomolar dissociation constant. To demonstrate if the selected spiegelmers are functional and suitable for cTnI detection in a sandwich type arrangement, AlphaLisa technology was leveraged and the obtained results demonstrated that spiegelmers with different epitope selectivity are suitable for specific detection of cTnI protein even in human plasma containing samples. These results suggest that spiegelmers could be considered in the development of the next generation cTnI monitoring assays.

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“…Troponin is a muscle-associated protein that is released into the blood circulation during cell injury, and it is used as a cardiac marker for screening and detecting cardiac injury [ 9 ]. Because of its cardiac specificity, the laboratory cardiac marker troponin may be the criterion for the diagnosis of myocardial injury [ 10 ]. AST, also named glutamate oxaloacetate transaminase (GOT), is released from necrotic cardiac myocytes and may be detected in serum [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac markers of multisystem inflammatory syndrome in children (MIS-C) in COVID-19 patients: A meta-analysis

Zhao

Patel

Huang

et al. 2021

The American Journal of Emergency Medicine

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Objective A meta-analysis of laboratory cardiac markers for multisystem inflammatory syndrome in children (MIS-C) was performed in patients with coronavirus disease 2019 (COVID-19). Methods Eight databases were searched until April 10, 2021, for studies on cardiac markers, including B-type natriuretic peptide (BNP)/N-terminal pro-BNP (NT-proBNP), troponin, aspartate aminotransferase (AST), in MIS-C patients. Results Of the 2583 participants enrolled in 24 studies, 1613 patients were diagnosed with MIS-C. MIS-C patients exhibited higher BNP levels than patients with non-severe COVID-19 [SMD ( 95% CI ): 1.13 (0.48, 1.77), p < 0.05]. No significant differences in BNP levels were observed between patients with MIS-C and severe COVID-19 [SMD ( 95% CI ): 0.29 (−0.07, 0.65), p = 0.117]. Comparisons of MIS-C patients to all COVID-19 patients revealed no significant differences in levels of troponin [SMD ( 95% CI ): 0.13 (−0.07, 0.32), p = 0.212] or AST [SMD ( 95% CI ): 0.10 (−0.11, 0.31), p = 0.336]. Compared to patients with non-severe MIS-C, those with severe MIS-C exhibited higher levels of BNP [SMD ( 95% CI ): 0.26 (0.04, 0.48), p < 0.05], but no differences in troponin [SMD ( 95% CI ): 0.05 (−0.06, 0.16) p = 0.387] or AST [SMD ( 95% CI ): 0.19 (−0.34, 0.71), p = 0.483] were observed. Moreover, there was no significant difference in BNP [SMD ( 95% CI ): −0.21 (−1.07, 0.64), p = 0.624] or troponin [SMD ( 95% CI ): −0.07 (−0.45, 0.31), p = 0.710] between MIS-C with and without coronary artery abnormality. Sensitivity analyses were performed to assess stability. No publication bias was detected based on Begg's test. Conclusions The key cardiac marker that showed differences between patients with MIS-C/non-severe COVID-19 and between patients with severe/non-severe MIS-C was BNP. Other markers, such as troponin and AST, did not exhibit notable differences in indicating cardiac injury between patients with MIS-C and COVID-19.

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High-sensitivity troponin assays: development and utility in a modern health-care system

Cited by 12 publications

References 73 publications

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department

Spiegelmer-Based Sandwich Assay for Cardiac Troponin I Detection

Cardiac markers of multisystem inflammatory syndrome in children (MIS-C) in COVID-19 patients: A meta-analysis

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