High-sensitivity Troponin Testing Research Articles

Used Indiscriminately, High-Sensitivity Troponin Testing Is Nonspecific

High-sensitivity troponin (hsTn) testing has been widely available in the UK and Europe for years and was recently approved for clinical use in the

High sensitivity troponin might be a marker of subclinical scleroderma heart involvement: a preliminary study

Introduction Although often asymptomatic, cardiac involvement is common in systemic sclerosis (SSc), and is associated with an increased morbidity and mortality. The aim of this study is to investigate whether high-sensitivity troponin (HSTn) might represent a useful tool to detect subclinical scleroderma heart involvement (SHI) in SSc. Methods We enrolled 65 consecutive SSc patients who performed HSTn test, electrocardiogram and an echocardiogram within six months of HSTn test. We acquired also data about N-terminal segment of proBNP (NT-proBNP) and cardiac magnetic resonance imaging (cMRI). We excluded patients with overt pulmonary arterial hypertension. We defined as subclinical SHI the presence of the following conditions: diastolic dysfunction, pericardial effusion, conduction abnormalities/arrhythmias, oedema and/or T2 weighted non-ischemic pattern showed by cMRI. Results Twelve patients showed SHI, and 23 and 29, respectively, had high levels of HSTn and of NT-proBNP. SHI is correlated with high levels of HSTn (p = 0.02) with a significant difference between HSTn values in patients with or without SHI (59 vs. 13 ng/mL; p = 0.0097). Moreover, among patients with abnormal NT-proBNP, 18 also had out of range HSTn (Spearman rank correlation 0.5; p<0.0001). According to ROC curve analysis, the best HSTn cut-off value in distinguishing between patients with and patients without SHI was 16 ng/mL (sensitivity 66.7%, specificity 83%; area under the curve: 0.77 (95% CI: 0.65-0.87) p<0.001. Conclusions Our data show a close relationship between HSTn and NT-proBNP in SSc patients with SHI. HSTn might be a marker of SHI while NT-proBNP seems to be less specific for heart dysfunction.

Redesigning the diagnostic pathway for chest pain patients in emergency departments

Patients presenting with chest pain at an emergency department in the United Kingdom receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, serial testing with two blood samples separated by at least six hours was necessary in order to analyse the change in troponin levels over time. New high-sensitivity troponin tests, however, allow the inter-test time to be shortened from six to three hours. Recent evidence also suggests that the new generation of troponin tests can be used to rule out AMI on the basis of a single test if patients at low risk of AMI present with very low cardiac troponin levels more than three hours after onset of worst pain. This paper presents a discrete event simulation model to assess the likely impact on the number of hospital admissions if emergency departments adopt strategies for serial and single testing based on the use of high-sensitivity troponin. Data sets from acute trusts in the South West of England are used to quantify the resulting benefits.

Hot Off the Press: The Use of Very Low Concentrations of High-sensitivity Troponin T to Rule Out Acute Myocardial Infarction Using a Single Blood Test.

Summary This prospectively planned, secondary analysis of data from a large multi-center trial evaluated the diagnostic characteristics of using hs-cTnT levels below the level of detection (LoD), along with EKG findings, to rule out AMI on presentation to the ED. The primary outcome was diagnosis of AMI and the secondary outcome was major adverse cardiac events (MACE) within 30 days. A total of 1,282 patients were included in the study, 16.6% of which were diagnosed with AMI at the index visit. This article is protected by copyright. All rights reserved.

Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests

ObjectiveTo validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain.MethodsInternational post hoc analysis of three prospective,...

Cardio-oncology interventions in outpatients referred for autologous bone marrow transplantation.

137 Background: Cancer patients (PTS) referred for autologous bone marrow transplantation (autoBMT) are frequently pre-treated with established cardiotoxins and as a result may not have adequate cardiac function to meet eligibility criteria for autoBMT. Furthermore, mobilizing and consolidation chemotherapy result in additional serial exposures with acute and long-term negative cardiac sequelae. Accordingly, these PTS represent a population with a major unmet need for appropriate cardiovascular screening and interventions. Aim: to evaluate the need and effectiveness of prospective multidisciplinary cardio-oncology assessment and intervention in an unselected outpatient population referred for autoBMT. Methods: From January 1, 2013 – December 31, 2013, PTS referred for autoBMT were systematically screened for comorbid conditions, cardiovascular risk factors and eligibility for transplant. Physical exam, laboratory (ECG, complete profile) and transthoracic echocardiogram with contrast were performed. Those with EF < 50%, increased IVsd/LVpWd, ECG abnormalities +/- significant cardiac history underwent proBNP and high sensitivity troponin testing. PTS with abnormal findings or decreased left ventricular (LV) function were referred to the Edmonton Cardio-Oncology REsearch (ENCORE) program. Results: 73 unique PTS were screened by the Edmonton autoBMT program. Of these, 16 (20%) were reviewed by ENCORE. Reasons for referral included: decreased LV function (n = 6, 38%); increased IVsd (n = 5, 31%); arrhythmia (n = 4, 25%); angina (n = 1, 5%). Pharmacotherapy was initiated for 6 PTS; additional modality or serial cardiac imaging for 12 PTS; urgent stent for 1 PT. 100% proceeded to autoBMT without adverse cardiovascular outcomes or mortality. Conclusions: With systematic screening, a high proportion of PTS referred for autoBMT required cardio-oncology assessment and interventions, with 100% proceeding safely as a result. ENCORE represents a novel approach in the provision of cardio-oncology expertise for autoBMT PTS acutely during the mobilizing and transplantation period. Future examination of our prospective dataset will elucidate the longer term effects of our interventions.

The year in cardiology 2015: acute coronary syndromes

The year 2015 has been productive in studies on pathophysiology of ACS. In particular on the different mechanisms of disease and related outcomes. New information has been published on the early diagnosis of ACS and on prevention and treatment of microvascular obstruction. With regard to antithrombotic treatment, the year 2015 has brought important new data that will change practice. Both the European Society of Cardiology (ESC)1 and the American College of Cardiology/American College of Cardiology (ACC/AHA)2 have published new guidelines on the management of acute coronary syndromes (ACS) in patients without persistent ST-segment elevation. In this review, we briefly highlight new recommendations only. With regard to early diagnosis of myocardial infarction (MI) ESC guidelines, for the first time, give a 1B recommendation for a rapid rule-out and rule-in protocol at 0 and 1 h if a high-sensitivity cardiac troponin test with a validated 0/1 h algorithm is available, with additional testing after 3–6 h if the first two troponin measurements are not conclusive and the clinical condition is still suggestive of ACS, while ACC/AHA recommend to measure troponin at presentation and 3–6 h after symptom onset. Both guidelines recommend an immediate invasive strategy within 2 hours of presentation in very high-risk patients, an early invasive strategy within 24 h in high-risk patients and an invasive strategy within 72 h in intermediate risk patients. Finally, ESC guidelines give 1A recommendation for the radial approach in experienced centres and provide a new flow chart for the management of antithrombotic drugs in patients with concomitant non-valvular atrial fibrillation ( Figure 1 ). They also give for the first time 3B recommendation for not to preloading patients in whom …

Beyond triage: the diagnostic accuracy of emergency department nursing staff risk assessment in patients with suspected acute coronary syndromes

ObjectivesTo establish the accuracy of emergency department (ED) nursing staff risk assessment using an established chest pain risk score alone and when incorporated with presentation high-sensitivity troponin testing as part...

Identifying Patients Suitable for Discharge After a Single-Presentation High-Sensitivity Troponin Result: A Comparison of Five Established Risk Scores and Two High-Sensitivity Assays

We compare the ability of 5 established risk scores to identify patients with suspected acute coronary syndromes who are suitable for discharge after a modified single-presentation high-sensitivity troponin result. This was a prospective observational study conducted in a UK district general hospital emergency department. Consecutive adults recruited with suspected acute coronary syndrome for whom attending physicians determined evaluation with serial troponin testing was required. Index tests were definitions of low risk applied to modified Goldman, Thrombolysis in Myocardial Infarction (TIMI), Global Registry of Acute Cardiac Events (GRACE), History, ECG, Age, Risk Factors, Troponin (HEART), and Vancouver Chest Pain Rule risk scores, incorporating either high-sensitivity troponin T or I results. The endpoint was acute myocardial infarction within 30 days. A test sensitivity threshold for acute myocardial infarction of 98% was chosen. Clinical utility was defined as a negative predictive value greater than or equal to 99.5% and identification of greater than 30% suitable for discharge. Nine hundred fifty-nine patients underwent high-sensitivity troponin T analysis and 867 underwent high-sensitivity troponin I analysis. In the high-sensitivity troponin T group, 79 of 959 (8.2%) had an acute myocardial infarction and 66 of 867 (7.6%) in the high-sensitivity troponin I group. Two risk scores (GRACE <80 and HEART ≤3) did not have the potential to achieve a sensitivity of 98% with high-sensitivity troponin T, and 3 scores (Goldman ≤1, TIMI ≤1, and GRACE <80) with high-sensitivity troponin I. A TIMI score of 0 or less than or equal to 1 and modified Goldman score less than or equal to 1 with high-sensitivity troponin T, and TIMI score of 0 and HEART score of less than or equal to 3 with high-sensitivity troponin I had the potential to achieve a negative predictive value greater than or equal to 99.5% while identifying greater than 30% of patients as suitable for immediate discharge. With established risk scores, it may be possible to identify greater than 30% of patients suitable for discharge, with a negative predictive value greater than or equal to 99.5% for the diagnosis of acute myocardial infarction, using a single high-sensitivity troponin test result at presentation. There is variation in high-sensitivity troponin assays, which may have implications in introducing rapid rule-out protocols.

309 Operational Impact and Patient Outcomes Following Implementation of High-Sensitivity Troponin Testing in Three Urban Emergency Departments

Highly sensitive troponin T (hsTnT) assays detect myocardial injury sooner, raising the possibility of improved throughput times for emergency department (ED) assessment of patients with suspected acute myocardial infarction (AMI). Few studies have explored the system-wide impact of hsTnT implementation on resource utilization. In this study, we evaluate the influence of hsTnT implementation on ED length of stay (LOS), consultation and admission rates for patients with suspected AMI.

PT123 The Triage Rule-Out Using Sensitive Troponin Study (TRUST). An observational study of early risk-stratification of patients with suspected cardiac chest pain and initiation of presentation high-sensitivity troponin testing in low risk Emergency Department patients

PT123 The Triage Rule-Out Using Sensitive Troponin Study (TRUST). An observational study of early risk-stratification of patients with suspected cardiac chest pain and initiation of presentation high-sensitivity troponin testing in low risk Emergency Department patients

How to respond to the incoming new era of the new generation, high sensitive cardiac troponin test

The new generation test of high sensitivity cardiac troponin has been used by European clinicians nearly for four years.In 2011, it was recommended by the latest ESC clinical guidelines for rapid exclusion of NSTE-ACS.In China, high-sensitivity cardiac troponin test has been oppreciated in many hospitals for three years actually, but it′s not utilized well due to the poor communication between clinical laboratory and clinicians.Clinicians have various opinions about this new test.Some doctors are interested in this new test, while some doctors do not know much about it.Consensus has been reached on the importance of cardiac troponin for the diagnosis and treatment for ACS.The new generation test solves many problems of the previous generations, such as low sensitivity, accuracy and delayed diagnosis.Therefore it could give doctors more help.In order to utilize this useful test well, the clinical laboratory should study it well first and then introduce it to clinicians.（Chin J Lab Med,2012,35:1081-1086） Key words: Troponin; Indicators and reagents; Sensitivity and specificity

PCV28 Cost-Effectiveness of Presentation and Delayed Troponin Testing for Acute Myocardial Infarction

To estimate the cost-effectiveness of delayed troponin testing for myocardial infarction (MI), as recommended in current guidelines, compared to troponin testing and other biomarkers at presentation. We developed a decision analytic model to estimate the cost-effectiveness of diagnostic strategies for MI, measured as the incremental cost per quality-adjusted life year (QALY) gained by each strategy compared to the next most effective alternative. The model was applied to a hypothetical population of 1000 patients attending hospital with symptoms suggesting MI but a normal or non-diagnostic electrocardiogram (ECG) and no major co-morbidities requiring hospital treatment. Sensitivity and specificity of the strategies were estimated by meta-analysis of diagnostic cohort studies of presentation troponin T. The risk of reinfarction and death (with and without treatment) was determined using data from a study by Mills et al, Lifetime QALYs were estimated from life expectancy and corresponding annual utilities. The discounted life expectancy of patients with MI and MI with reinfarction was estimated from Polanczyk et al, while the utility of patients with MI was estimated from Ward et al. In all scenarios tested presentation high sensitivity troponin testing was the most effective strategy with an incremental cost-effectiveness ratio (ICER) below the £20,000/QALY threshold. Delayed troponin testing was only likely to be cost-effective if a discharge decision could be made as soon as a negative result was available and the £30,000/QALY threshold was used. Delayed troponin testing is unlikely to be cost-effective compared to high sensitivity troponin testing at presentation in most scenarios. Current guidelines recommending 10-12 hour troponin testing does not appear to promote cost-effective use of hospital resources, unless services are in place to allow rapid decision making once delayed test results are available.

High-sensitivity troponin testing cost effective

High-sensitivity troponin testing cost effective

122 The Effect of Implementing High-Sensitivity Troponin Testing on Operational Efficiency in Three Large Urban Emergency Departments

New highly sensitive cardiac Troponin T (hsTnT) assays are becoming widely adopted in Canadian hospitals, raising the possibility of improved throughput times for emergency department (ED) assessment. Few studies have addressed the effects of introducing the hsTnT assay on ED and hospital resource consumption. In this study, we evaluate the impact of hsTnT implementation on ED length of stay (LOS), consultation and admission rates for patients with suspected AMI. This time-series analysis involved a cohort of all patients presenting to three Calgary adult EDs evaluated using hsTnT or its predecessor, conventional TnT (cTnT). The hsTnT assay was implemented on January 31, 2012. An educational intervention for ordering physicians and nurses preceded the implementation of hsTnT testing. The cutoff value used for diagnosis of AMI was 50 ng/ml. Data was collected for February 12, 2011-April 22, 2011: control period one year prior to hsTnT implementation (Ctrl1yrPre); November 20, 2011-January 28, 2012: immediately pre-hsTnT implementation (Immed-pre); February 12, 2012- April 21, 2012: immediately post-hsTnT implementation (Post). Subjects included all ED patients, excluding physician-confirmed STEMIs, who had at least one cTnT or hsTnT drawn as a marker for symptoms suspicious of AMI. The ED information system database was used to collect outcome data. Categorical variables were analyzed using Pearson's Chi-squared test. The Mann-Whitney U test was used to compare median values between the three study periods. We analyzed data from 6742 patients Ctrl1yrPre, 6952 Immed-pre and 5822 Post; demographic characteristics between the groups were similar. A smaller proportion of patients had troponin assays performed in the Post period, compared to the Ctrl1yrPre and Immed-pre periods (12.5% Post vs. 15.8% Ctrl1yrPre and 15.4% Immed-pre). A significant reduction in median ED LOS was observed following hsTnT implementation: 6.53 hours (h) in Ctrl1yrPre, 6.52 h in Immed-pre, and 6.04 h in Post (p<0.001). The proportion of patients with third troponins ordered decreased from 7.9% in Ctrl1yrpre and 7.2% in Immed-pre to 5.9% in Post (p<0.001). There was no statistically significant change in the number of Cardiology consultations or admissions following hsTnT implementation. Implementing hsTnT testing at three centers with an equivalent cutoff value and a change in nurse-initiated TnT ordering resulted in a decreased ED LOS for patients with suspected AMI and no increase in cardiology resource utilization. This finding may be attributable to a carefully considered hsTnT assay implementation strategy that reduced the number of unnecessary TnT assays performed.

Cost-effectiveness of presentation versus delayed troponin testing for acute myocardial infarction

ObjectivesTo estimate the cost-effectiveness of delayed troponin testing for myocardial infarction compared with troponin testing at presentation.DesignDecision analysis modelling of cost-effectiveness using secondary data sources.SettingAcute hospitals in the UK.PopulationPatients attending...

Consensus statement on the use of high sensitivity cardiac troponins

The increased sensitivity of high sensitivity cardiac troponin assays comes at a cost of decreased specificity, and “false positive” diagnosis of acute coronary syndromes has made clinicians wary of their use, fearing unnecessary hospitalisations, angiography and revascularisation. The Ethics and Guidelines Standing Committee of SA Heart Association convened a meeting of cardiologists, chemical pathologists, emergency medicine specialists and industry representatives to discuss the role of high sensitivity troponin (hsTn) testing. An international expert provided guidance, and this Consensus Statement is the product of that meeting. It is recommended that hsTn assays be widely adopted as the preferred biomarker for diagnosis of myocardial infarction. Pathology laboratories will standardise the units of measurement and the reporting of results. Rules for interpretation of results and algorithms for their application are provided. Separate algorithms apply to troponin T and troponin I, and the several troponin I assays on the market each have different numerical values. Use of high sensitivity troponin assays will result in earlier diagnosis of myocardial infarction, more reliable ruling out of myocardial infarction, and shortening of chest pain triage (to 4 hours), compared to former assays.

Chest pain research in Australasian emergency medicine: Putting our mark on the world stage

Chest pain research in Australasian emergency medicine: Putting our mark on the world stage