hs-cTnT Test Research Articles

High-Sensitivity Cardiac Troponin T Reporting, Clinical Outcomes, and Health Care Resource Use

Despite being recommended by clinical guidelines, substantial concerns remain regarding the use of high-sensitivity cardiac troponin assays and whether it is associated with increased resource use, myocardial infarction (MI) or myocardial injury diagnoses, and procedural rates. To characterize the association of reporting high-sensitivity cardiac troponin T (hs-cTnT) to the lowest limit of quantification vs conventional troponin reporting with clinical outcomes. This cohort study used a historically controlled baseline and follow-up design to compare clinical outcomes after changing hs-cTnT reporting to the lowest limit of quantification. All patients aged 18 years or older presenting to any public emergency department (ED) in the state of South Australia between February 1, 2020, and February 28, 2021, who had an hs-cTnT test in the 6 months before and after the change in troponin reporting practice were included. Outcomes were assessed after adjusting for patient characteristics using inverse probability treatment weighting. The data analysis was performed between May 1, 2022, and July 27, 2023. hs-cTcnT reporting. The main outcomes were frequency of diagnosed MI, coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG); hospital length of stay; and ED discharge rate as measured using time-to-event Cox regression models. The secondary outcome was the composite 12-month event rate of all-cause mortality, MI, and myocardial injury. A total of 40 921 patients were included, of whom 20 206 were included in the unmasked hs-cTnT reporting group (median [IQR] age, 62.0 [46.0-77.0]; 10 120 females [50.1%]) and 20 715 were included in the conventional troponin reporting group (median [IQR] age, 63.0 [47.0-77.0] years; 10 752 males [51.9%]). Unmasked hs-cTnT reporting was associated with higher ED discharge rates (45.2% vs 39.0%; P < .001) and a shorter median hospital length of stay (7.68 [IQR, 4.32-46.80] hours vs 7.92 [IQR, 4.56-49.92] hours; P < .001). There was no difference in diagnosis of MI, coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft. The composite of all-cause mortality, MI, and myocardial injury at 12 months was similar (adjusted hazard ratio, 0.95; 95% CI, 0.90-1.01; P = .09). This cohort study found that unrestricted reporting of hs-cTnT results to the lowest limit of quantification was not associated with an increase in the diagnosis of MI, invasive coronary procedures, or harm at 12 months but may be associated with improved hospital resource use.

Performance evaluation of a novel high-sensitivity cardiac troponin T assay: analytical and clinical perspectives.

To evaluate the analytical characteristics of anovel high-sensitivity cardiac troponin T (hs-cTnT) test onthe automatic light-initiated chemiluminescent assay (LiCA®) system, and validated its diagnostic performance for non-ST-segment elevation myocardial infarction (NSTEMI). Studies included an extensive analytical evaluation and established the 99th percentile upper reference limit (URL) from apparently healthy individuals, followed by a diagnostic performance validation for NSTEMI. Sex-specific 99th percentile URLs were 16.0 ng/L (1.7 % CV: coefficient of variation) for men (21-92 years) and 13.4 ng/L (2.0 % CV) for women (23-87 years) in serum, and 30.6 ng/L (0.9 % CV) for men (18-87 years) and 20.2 ng/L (1.4 %CV) for women (18-88 years) in heparin plasma. Detection rates in healthy individuals ranged from 98.9 to 100 %. An excellent agreement was identified between LiCA® and Elecsys® assays with a correlation coefficient of 0.993 and mean bias of-0.7 % (-1.8-0.4 %) across the full measuring range, while the correlation coefficient and overall bias were 0.967 and-1.1 % (-2.5-0.3 %) for the lower levels of cTnT (10-100 ng/L), respectively. At the specific medical decision levels (14.0 and 52.0 ng/L), assay difference was estimated to be <5.0 %. No significant difference was found between these two assays in terms of area under curve (AUC), sensitivity and specificity, negative predictive value (NPV) and positive predictive value (PPV) for the diagnosis of NSTEMI. LiCA® hs-cTnT is a reliable 3rd-generation (level4) high-sensitivity assay for detecting cardiac troponin T. The assay is acceptable for practical use in the diagnosis of NSTEMI.

High-Sensitivity Cardiac Troponin T in Prediction and Diagnosis of Early Postoperative Hypoxemia after Off-Pump Coronary Artery Bypass Grafting.

To investigate the relationship of preoperative high-sensitivity cardiac troponin T (hs-cTnT) with early postoperative hypoxemia (EPH) following off-pump coronary artery bypass grafting (OPCAB). Records of patients undergoing OPCAB between 2018 and 2022 were reviewed. Baseline characteristics and postoperative arterial blood gas analysis were derived from the cardiovascular surgery electronic medical records. Preoperative hs-cTnT levels were measured routinely in all patients. Logistic regression analyses were performed to test the association of preoperative hs-cTnT with EPH. A total of 318 OPCAB patients were included, who had a preoperative hs-cTnT test available for review. Before surgery, 198 patients (62%) had a rise in hs-cTnT level (≥14 ng/L) and 127 patients (40%) had a more severe hs-cTnT level (≥25 ng/L). The preoperative hs-cTnT level was associated with EPH (odds ratio per ng/L, 1.86; 95% confidence interval 1.30-2.68; p &lt; 0.001), prolonged intensive care unit stay (odds ratio, 1.58; 95% confidence interval 1.08-2.32; p = 0.019), and delayed extubating time (odds ratio, 1.63; 95% confidence interval 1.15-2.34; p = 0.007). On multivariable analysis, adjusted for BMI, hypertension, smoking status, serum creatinine, and cardiac function, preoperative hs-cTnT remained an independent factor associated with EPH. Elevation of hs-cTnT concentrations are significantly associated with EPH after OPCAB. Review of presurgical hs-cTnT concentration may help identify patients who would benefit from OPCAB to improve surgical risk assessment.

A single hs-cTnT test to exclude AMI.

A single hs-cTnT test to exclude AMI.

Outcomes associated with the high sensitivity cardiac troponin testing in patients presenting with non-cardiovascular disorders.

There are limited data regarding the utility of troponin testing in patients presenting with non-cardiovascular (CV) symptoms as the primary manifestation. The study population comprised 2057 patients who presented to the emergency department (ED) of a US healthcare system with non-CV symptoms as the primary manifestation between January and September 2018. We compared the effect of high-sensitivity cardiac troponin T (hs-cTnT) (n=901) after its introduction vs. 4th generation cTnT (n=1156) on the following outcomes measures: ED length of stay (LOS), coronary tests/procedures (angiography or stress test), and long-term mortality. Mean age was 64±17yrs., and 47% were female. Primary non-CV manifestations included pneumonia, obstructive pulmonary disease, infection, abdominal-complaint, and renal failure. Mean follow up was 9±4months. Patients' demographics and medical history were clinically similar between the two troponin groups. A second cTn test was obtained more frequently in the hs-cTnT than cTnT (84% vs. 32%; p<0.001), possibly leading to a longer ED stay (8.1±8.2h vs 5.6±3.4h, respectively; p<0.001). Coronary tests/procedures were performed at a significantly higher rate in the hs-cTnT than cTnT following the introduction of the hs-cTnT test (28% vs. 22%, p<0.001). Multivariate analysis showed that following the introduction of hs-cTnT testing, there was a significant 27% lower risk of long-term mortality from ED admission through follow-up (HR=0.73, 95%CI 0.54-0.98; p=0.035). In conclusion, we show that in patients presenting primarily with non-CV disorders, the implementation of the hs-cTnT was associated with a higher rate of diagnostic coronary procedures/interventions, possibly leading to improved long-term survival rates.

Cardiac troponins: are there any differences between T and I?

The most recent international guidelines recommend the measurement of cardiac troponin I (cTnI) and cardiac troponin T (cTnT) using high-sensitivity methods (hs-cTn) for the detection of myocardial injury and the differential diagnosis of acute coronary syndromes. Myocardial injury is a prerequisite for the diagnosis of acute myocardial infarction, but also a distinct entity. The 2018 Fourth Universal Definition of Myocardial Infarction states that myocardial injury is detected when at least one value above the 99th percentile upper reference limit is measured in a patient with high-sensitivity methods for cTnI or cTnT. Not infrequently, increased hs-cTnT levels are reported in patients with congenital or chronic neuromuscular diseases, while the hs-cTnI values are often in the normal range. Furthermore, some discrepancies between the results of laboratory tests for the two troponins are occasionally found in individuals apparently free of cardiac diseases, and also in patients with cardiac diseases. In this review article, authors discuss the biochemical, pathophysiological and analytical mechanisms which may cause discrepancies between hs-cTnI and hs-cTnT test results.

Is there excessive troponin testing in clinical practice? Evidence from emergency medical admissions

Aim: To investigate whether excessive high-sensitivity cardiac troponin T (hscTnT) testing, in non-cardiac presentations, increases hospital length of stay (LOS) by driving down-stream investigations. Methods: We report on all hscTnT tests in emergency medical admissions, performed over a 9-year period between 2011-2019. Troponin testing frequency in different risk cohorts was determined and related to 30-day in-hospital mortality with a multivariable logistic regression model adjusted for other outcome predictors. Downstream utilization of procedures/services was related to LOS with zero truncated Poisson regression. Results: There were 66,475 admissions in 36,518 patients. hscTnT was tested in 24.4% of admissions, more frequently in the elderly (>70 years 33.4%, >80 years 35.9%), cardiovascular presentations (33.6%) and in those with high comorbidity (42.2%), and reduced in those with neurologic presentations (20%). A hscTnT request predicted increased 30-day in-hospital mortality OR 3.33 (95% CI: 3.06, 3.64). The univariate odds ratio (OR) of hscTnT test result was 1.45 (95% CI: 1.42, 1.49) and was semi-quantative with worsening outcomes as hscTnT increased. It remained predictive in the fully adjusted model OR 1.17 (95% CI: 1.09, 1.26). LOS was linearly related to the number of procedures/services performed. hscTnT testing did not increase LOS or number of procedures/services Conclusion: A clinical request for hscTnT testing is prognostic and risk categorises. Subsequent resource utilization, if increased, appears an epiphenomenon related to risk categorisation, rather than being driven by inappropriate hscTnT testing.

Cancer Survivorship and Subclinical Myocardial Damage.

Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicities of cancer therapies and a high burden of CVD risk factors. We sought to evaluate the association of cancer survivorship with subclinical myocardial damage, as assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT) test results. We included 3,512 participants of the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013) and were free of CVD (coronary heart disease, heart failure, or stroke). We used multivariate logistic regression to evaluate the cross-sectional associations of survivorship from any, non-sex-related, and sex-related cancers (e.g., breast, prostate) with elevated hs-cTnT (≥14 ng/L). Of 3,512 participants (mean age, 76 years; 62% women; 21% black), 19% were cancer survivors. Cancer survivors had significantly higher odds of elevated hs-cTnT (OR = 1.26, 95% CI: 1.03, 1.53). Results were similar for survivors of non-sex-related and colorectal cancers, but there was no association between survivorship from breast and prostate cancers and elevated hs-cTnT. Results were similar after additional adjustments for CVD risk factors. Survivors of some cancers might be more likely to have elevated hs-cTnT than persons without prior cancer. The excess burden of subclinical myocardial damage in this population might not be fully explained by traditional CVD risk factors.

The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: an observational study

BackgroundThe 3-h high-sensitivity cardiac troponin T (hs-cTnT) algorithm is the most commonly used scheme to diagnose acute myocardial infarction. The 1-h hs-cTnT algorithm has recently been approved by the European Society of Cardiology as an alternative algorithm for earlier diagnosis. If the hs-cTnT test cannot discriminate the diagnosis of the patient at 1 h, the patient is defined as observational group. Their test must be repeated at 3 h. A high prevalence of this group may indicate a low clinical utility of the 1-h hs-cTnT algorithm. This study was aimed to estimate the proportion of the observational group in Thai emergency department (ED) patients and also the time to rule-in/out between both the algorithms.MethodsA historical control study was conducted in patients with chest pain for 1–12 h at the ED of Siriraj Hospital, Bangkok, Thailand. The study compared two groups: one prospective group of all patients evaluated with the 1-h hs-cTnT algorithm between June and September 2017 and one historical control group evaluated with the 3-h hs-cTnT algorithm between January and March 2017.ResultsA total of 130 patients were included (3-h hs-cTnT algorithm group n = 65 and 1-h hs-cTnT algorithm group n = 65). Twelve patients [18.5% (95% CI 10.0–30.1)] were categorized as observational group in the 1-h hs-cTnT algorithm group. The mean rule-in/out times in the 3-h hs-cTnT algorithm and 1-h hs-cTnT algorithm groups were 238 min (SD 63.3) and 134 min (SD 68.5), respectively (both p < 0.001). The time to disposition was also shortened in the 1-h hs-cTnT algorithm group (p < 0.001). Multivariable regression analysis performed to identify and adjust for confounders among patient characteristics revealed no significant confounders.ConclusionsThe use of the 1-h hs-cTnT algorithm in the ED resulted in an acceptable proportion in the observational group and a decreased time to rule-in/out compared with the 3-h hs-cTnT algorithm.

Clinical application of high-sensitivity cardiac troponin T test in acute myocardial infarction diagnosis.

The aim of this study was to investigate the clinical application of a high-sensitivity cardiac troponin T (hs-cTnT) test in the diagnosis of acute myocardial infarction (AMI). Serum levels of hs-cTnT and cardiac troponin I (cTnI) were detected in 240 AMI patients and 200 healthy donors and used to plot receiver operating characteristic (ROC) curves. A clinically applicable diagnostic cut-off value of hs-cTnT was determined from the ROC curve and the diagnostic accuracy of hs-cTnT and cTnI levels in AMI were compared.The serum hs-cTnT levels in the AMI group were higher than 0.014 ng/mL (the 99th percentile of the healthy population), among which hs-cTnT levels in patients with ST-segment elevation myocardial infarction (STEMI) were higher than in patients with non-STEMI (NSTEMI). The area under the ROC curve (AUC) for hs-cTnT was significantly higher than for cTnI, and the detection combining hs-cTnT and creatine kinase isoenzyme (CK-MB) further increased the AUC. When 0.014 ng/mL was set as the cut-off value for hs-cTnT, the diagnostic sensitivity for AMI reached 100% but the specificity was only 45.5%. The diagnostic ability of hs-cTnT for AMI peaked at a cut-off value of 0.035 ng/mL, resulting in the highest Youden index (0.654) and sensitivity and specificity values of 91.8 and 74.9%, respectively. The diagnostic utility of the hs-cTnT test for AMI is superior to the traditional cTnI method. However, since hs-cTnT levels of non-AMI patients can be over the diagnostic cut-off value, further studies are necessary to define clinically applicable cut-off values of hs-cTnT.

Evaluation in an emergency department of rapid separator tubes containing thrombin for serum preparation prior to hs-cTnT and CK-MB analyses

BackgroundIn our emergency department, we collect blood in Rapid Serum Tubes (RSTs; Becton Dickinson, Franklin Lakes, NJ), in which clotting times are reduced. We investigated the influence of RST use on cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) test results, in comparison with the use of tubes featuring a separator gel containing a clotting activator (SSTs; Green-vac, Yongin, Korea).MethodsSamples from 60 patients were divided into equal aliquots and placed into RSTs and SSTs; hs-cTnT and CK-MB concentrations were determined using an autoanalyzer (Elecsys 2010) running commercial assays (Roche Diagnostics, Penzberg, Germany). Between-tube differences in CK-MB and hs-cTnT values were compared using the paired t-test, and correlations among variables were evaluated by calculation of Spearman correlation coefficients (r values). Deming regression analysis was performed and Bland-Altman plots were constructed.ResultsThe hs-cTnT and CK-MB test results obtained from samples placed into RSTs and SSTs did not differ (p > 0.1). The correlations between the concentrations of hs-cTnT and CK-MB in samples placed into RSTs and SSTs were good; both r values were unity (p < 0.001). Deming regression analysis yielded the equation: RST [hs-cTnT] = 0.98 SST [hs-cTnT] + 0.69 pg/ml; and RST [CK-MB] = 0.95 SST [CK-MB]–0.09 ng/ml. The biases of 1.4 pg/ml (95% CI: minus 8.1–10.7 pg/ml) for hs-cTnT levels and 0.249 ng/ml (95% CI: minus 0.682–1.681 ng/ml) for CK-MB levels assayed using either tube was acceptable.ConclusionThe hs-cTnT and CK-MB test results did not significantly differ when either tube was used. RST tube use was associated with a short clotting time; this was an advantage in an emergency laboratory setting.

Clinical application of high-sensitivity cardiac troponin T assay in the diagnosis of acute myocardial infarction

Objective To evaluate the clinical application of hs-cTnT in diagnosis of AMI. Methods The detectable rates of hs-cTnT and con-cTnT from 147 AMI ( including 122 NSTEMI )patients on immediate admission were compared. The related biological markers including hs-cTnT, con-cTnT, CKMB mass and MYO were determined for all samples from 481 patients with chest pain on immediate admission and 4 h, 12 h ,20 h and 28 h after admission. The receiver operating characteristic curve was used to evaluate the sensitivity and specificity of all markers. The change rates of hs-cTnT within 4 hours from AMI group, non-AMI heart disease group, AMI related high risk disease group and control group were compared with serial detection. Results The detection rates of hs-cTnT for AMI and NSTEMI patients were 90. 3% and 91.0%, and both were significantly higher than the rates of con-cTnT, which were 61.9% and 60. 6% (x2 =23.08,18. 64,all P＜0. 01 ). Among different makers obtained from different collecting times,hs-cTnT had the highest detection rate. For admission cases, the area under curve of hs-cTnT, con-cTnT,CKMB mass and MYO were 0.935, 0.851, 0.827 and 0.769 respectively, and the differences have statistical significance(Z1 = 3. 13, Z2 = 4. 46, Z3 = 5.62, all P ＜ 0. 05 ). Besides, there was a significant difference between the change rate of hs-cTnT of AMI and other groups (x2=166.09,P＜0. 01).Conclusions In comparison with con-cTnT, hs-cTnT could provide reliable results for earlier diagnosis of AMI, and could also reduce misdiagnosis and missed diagnosis of NSTEMI. Combining single test of hs-cTnT with serial tests was superior to using cut-off value alone in diagnosis. Moreover, it could be helpful to distinguish non-AMI patients from true AMI patients due to the improved detection sensitivity. Because of its good diagnostic performance, hs-cTnT test may limit the application value of some other early markers. Key words: Troponin T; Myocardial infarction; Diagnostic techniques and procedures; Evaluation studies