Increasingly Sensitive Assays for Cardiac Troponins

Lemos, James A. de

doi:10.1001/jama.2013.5809

Cited by 170 publications

(137 citation statements)

References 55 publications

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“…Increased levels of pro-coagulant factors (such as plasminoger-activator inhibitor type-1, fibrinogen or platelet activity and aggregation) [91,93,94] are linked to OSA severity and circadian variation contributing to early morning fibrinolytic activity [98,99] and cardiovascular events [100][101][102][103][104]. These same mechanisms associated with cardiac myocyte stress have been shown to be triggers for the release of cTns and BNPs [75,105], making these biomarkers a potential indicator for OSA-related cardiovascular risk.…”

Section: Patient Positioningmentioning

confidence: 99%

“…Troponin is a protein complex involved in muscle contraction that is comprised of three distinct subunits: troponin T (cTnT), troponin I (cTnI) and troponin C (cTnC) [105]. The troponin T (largest subunit; 37-39 kiloDalton) and troponin I (26 kiloDalton) isoforms are specifically involved in cardiac muscle contraction, while the troponin C isoform is involved in cardiac as well as skeletal muscle contraction.…”

Section: Cardiac Troponins: a Marker For Cardiovascular Riskmentioning

confidence: 99%

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Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

et al. 2016

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Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity.

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Section: Patient Positioningmentioning

confidence: 99%

Section: Cardiac Troponins: a Marker For Cardiovascular Riskmentioning

confidence: 99%

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

et al. 2016

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“…As described above, the longitudinal monitoring of serial cTn changes is undoubtedly more effective in classifying patients with acute or chronic structural heart disease. Accordingly, a number of algorithms incorporating both baseline hsTn concentrations and changes in values over serial measurements have been proposed to address marker specificity concerns and to allow more accurate ruling out and ruling in of AMI [39].…”

Section: : Increasing Ctn Positivity Ratesmentioning

confidence: 99%

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Ferraro¹,

Panteghini

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The availability of so-called high-sensitivity troponin assays (hsTn) has scored a compelling goal for laboratory medicine, allowing the safe clinical application of international recommendations for the definition of acute myocardial infarction (AMI). However, the introduction of hsTn has not been welcomed by clinicians, claiming an increase in false-positive results. Here we critically trace back the steps following the introduction of hsTn by referring to the 5-year practical experience in our academic hospital and to suitable information available in the literature. In agreement with published data, we found that hsTn introduction was associated with an increased number of AMI diagnoses, whereas the test volume, the revascularization rate, and the proportion of cases with negative angiography findings remained virtually unchanged. Fast-track protocols for ruling out AMI have been further optimized to recommend sampling at presentation and after 3 h only. We focus on a cost-effective use of hsTn that can account for all clinical variables increasing the pre-test probability in order to ensure that tests are ordered only for patients at medium to high risk for acute coronary syndrome (ACS). To guide interpretation of results, hsTn typical release patterns suggestive for AMI should be identified by evaluating the significance of concentration changes. hsTn have markedly shortened the time to rule out or rule in AMI and has the potential to improve the prognostic assessment of critical patients in clinical contexts different from ACS.

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“…According to Biener et al [6], in patients presenting at ED, using hsTn T the highest capability to discriminate NSTEMI from non-ACS is achieved by adding a δ value of >53% as decisional criterion to the 99th percentile cut-off applied to the admission value. Thus, hsTn changes in values over serial measurements, joined to baseline concentrations, incorporated in running algorithms allow more accurate AMI diagnostics [7].…”

Section: Introductionmentioning

confidence: 99%

Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome

Ferraro

Dolci²,

Panteghini³

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound.

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Increasingly Sensitive Assays for Cardiac Troponins

Cited by 170 publications

References 55 publications

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Fast track protocols using highly sensitive troponin assays for ruling out and ruling in non-ST elevation acute coronary syndrome

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