Defining rise and fall of cardiac troponin values
|
|
- Herbert Rogers
- 5 years ago
- Views:
Transcription
1 Defining rise and fall of cardiac troponin values Doable but Not Simple Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory Medicine and Pathology Mayo Clinic and Medical School Rochester, Minnesota Chair, Biomarker Subcommittee of the Global Task Force *Dr. Jaffe is a has been a consultant to most of the major diagnostic companies as well as Amgen. CP
2 ctnt Determinants of Elevation in the Community* 40 P< % with elevated ctnt >3 Risk determinants present (no.) No. 2, *Circulation, 113: , 2006 CP CP
3 Prevalence of Detectable ctnt & levels > 99 th Percentile URL. ctnt Level, ng/ml Sample Sample Sample Weight-Adjusted Weight-Adjusted Size, Prevalence, % Prevalence, Group No. No. (%) (95% Cl) No. (%) 95% Cl) Overall population (27.0) 25.0 ( ) Restricted population Without CHD (26.0) 24.2 ( ) Without cardiovascular disease (24.8) 23.7 ( ) Without cardiovascular disease or CKD a Without cardiovascular disease, CKD, subclinical heart disease, diabetes, or hypertension b (24.0) 23.1 ( ) (20.0) 19.3 ( ) 122 (3.4) 103 (3.0) 2.0 ( ) 1.8 ( ) 82 (2.5) 1.9 ( ) 65 (2.3) 1.2 ( ) 43 (1.7) 1.1 ( ) CP
4 All-Cause Mortality by Cardiac Troponin T (n=733) Cumulative survival (%) Time since blood draw (years) ctnt <0.01 g/l ctnt 0.04 g/l ctnt 0.04 to 0.10 g/l ctnt 0.10 g/l Patients at risk (no.) Baseline 1 yr 2 yr 2.5 yr ctnt <0.01 g/l ctnt 0.01 to <0.04 g/l ctnt 0.04 to <0.10 g/l ctnt 0.10 g/l Circulation 106:2944, 2002 CP CP
5 TnT (ng/l) TnT (ng/l) Above cutpoint (%) Age Dependence of hsctnt Values ED Patients n= Population Cohort ED Pt Above Given Cut Off Values (%) Age >65 yr th Age <65 yr Age (yr) Age (yr) TnT cutpoint (ng/l) Hammarsten et al: Clin Chem, 2012 CP
6 99 th Percentile Values in Normal Subjects Measured By Contemporary, Sensitive and High-Sensitivity Cardiac Troponin Assays High Sensitivity 99 th Percentile Percent Measurable Male 99 th Percentile Female 99 th Percentile LoD N ng/l >LoD ng/l ng/l ng/l Abbott ARCHITECT Beckman Access Siemens Dimension Vista Singulex Erenna Roche ctnt Apple et al: CLINCHEM/2012/ CP
7 Changes in ctnt in Dialysis Patients with ACS ctnt (µmol/l) Nephron Clin Prac 98:c87, 2004 Days CP CP
8 Delta Guidance Must use fixed timing The greater the change, the more likely AMI The lesser the change, the less likely AMI CP
9 CV (%) Cardiac Troponin T Precision Profile 50,0 99 th % value = <0.01 ng/ml 40,0 10% CV value = ng/ml 30,0 20,0 10,0 ROC value = 0.1 ng/ml 0,0 0,00 0,02 0,04 0,06 0,08 0,10 0,12 0,14 0,16 0,18 Concentration (µg/l) CP
10 Determining Assay Values are Different CP
11 Use of High Sensitivity Troponin T to Diagnose Myocardial Infarction Clinical setting consistent with myocardial ischemia Baseline <14 ng/l ng/l 53 ng/l Retest hstnt 3 hours after symptom onset or if timing of symptom onset is unclear at 6 hours after presentation Change <50% ng/l 53 ng/l Change 50% Change <20% Change 20% 14 ng/l rules out MI with >90% probability If 14 ng/l then proceed to middle part of algorithm Adverse prognosis Retest hstnt at 6, 12 hr White HD; AHJ 2010 Myocardial infarction Evidence-based treatments CP
12 ug/l Absolute and Relative Changes of ctn Over 1- and 2-hours Hs-cTnT 1h absolute changes Hs-cTnT 2h absolute changes ctnl Ultra 1h absolute changes ctnl Ultra 2h absolute changes 300 Hs-cTnT 1h relative changes Hs-cTnT 2h relative changes ctnl Ultra 1h relative changes ctnl Ultra 2h relative changes % AMI Unstable angina Cardiac but not CAD Non- Unknown cardiac chest pain -100 AMI Unstable angina Cardiac but not CAD Non- Unknown cardiac chest pain Reichlin et al: Circulation 124:135, 2011 CP
13 Absolute and Relative Changes in Patients with AMI, Unstable Angina and Non-Cardiac Chest Pain Non-STEMI UAP Non-ACS Non-STEMI UAP Non-ACS Absolute change (log) Relative change (log) Mueller et al: Clinical Chemistry 58:1 (2011) CP
14 Sensitivity ROC Analysis by Deltas % Change [(y-x)/x *100] Absolute value of % Change Change (y-x) Absolute value of Change 100-specificity Apple FS et al: Clin Biochem (2012) CP
15 Sensitivity Diagnostic Increases in ctn (Christchurch ED Trial) 1.0 Baseline Total Hs TnT Abbott TnT CKMB Reference line specificity specificity Aldous et al: Ann Clin Biochem 48:241, 2011 CP
16 Reasons for Difficulty Calculating the Proper Delta Value Problems with the gold standard diagnosis Inclusion of patients with large infarctions diagnosed with less sensitive assays will increase deltas Inclusion of patients based on elevations of ctn alone based on adjudication criteria will reduce deltas CP
17 Sensitivity High sensitive troponin T (pg/ml) Sensitivity Relationship of hsctnt and Plaque Characteristics 100 Detection of Non-Calcified Plaque Classified by Plaque Composition P<0.001 P<0.001 P<0.001 P=NS Hs TnT>10.5 * AUC= specificity SE= % CI= Detection of 5 0 Normal vessels (n=46) Only calcified plaque (n=26) Non- Calcified Plaque (n=44) Remodeled Plaque (n=8) Remodeled Plaque * Hs TnT> AUC=0.90 SE=0.07 * Using a cut-off value of hstnt=14 pg/ml Korosoglou et al: Heart 97: % CI= specificity CP
18 Reasons for Difficulty Calcuating the Proper Delta Value Problems with the gold standard diagnosis Flow dependence of release High sensitivity means small changes make big differences What metric is desired to optmize clinical performance; i.e. sensitivity vs specificity CP
19 Sensitivity Specificity Defining the Optimal Delta: The Tension Between Sensitivity and Specificity Sensitivity Specificity Relative change in hstni concentration Data from Keller et al (20) CP
20 Reasons for Difficulty Calcuating the Proper Delta Value Problems with the gold standard diagnosis Flow dependence of release High sensitivity means small changes make big differences What metric is desired to optmize clinical performance; i.e. sensitivity vs specificity Spontaneous changes in those without AMI CP
21 Short-Term Analytical and Biological Variation by hs-ctnl Assays Abbott a Beckman a Roche (E170) b Siemens a Singulex c CV-A (%) d CV-I (%) CV-G (%) NA Index of individuality NA RCV (%) e NA NA 47.0 NA NA RCV increase (%) f NA RCV decrease (%) f NA Within-individual mean (ng/l) NA a Apple et al (38); b Vasile et al (36); c Wu et al (35) d CV-A, analytical CV; CV-I, within-individual CV; CV-G, between individual CV; NA, not available; RCV, relative change value; e REC percentage applies to parametric data f RCV increase and decrease percentages refer to nonparametric data and are log-transformed Apple et al: Clin Chem 58:1, 2012 CP
22 PERCENTILES OF CHANGE IN ctnt CONCENTRATION IN CORONARY CARE UNIT PATIENTS WITHOUT MI. Relative change, %.. Absolute change, ng/l. Diagnosis 50 th (95% Cl) 97.5 th (95% Cl) 50 th (95% Cl) 97.5 th (95% Cl) n a All diagnoses 10 (10-11) 59 (48-71) 1.6 ( ) 14.1 ( ) 866 Heart failure 10 ( 9-12) 51 (38-65) 3.1 ( ) 30 ( ) 204 Stable angina pectoris 10 ( 9-1 2) 67 (34-99) 1.4 ( ) 13.6 ( ) 343 Atrial fibrillation 9 ( 6-12) 66 (29-104) 1.1 ( ) 9.1 ( ) 86 Noncardiac chest pain 12 (10-15) 64 (46-82) 1.2 (1-1.5) 7.5 ( ) 229 a Number of ctnt measurements included in calculations. b NA, not applicable, because the absolute change in ctnt concentration differed among diagnosis groups (heart failure vs atrial fibrillation, stable angina pectoris, and noncardiac chest pain, all P <0.02, and atrial fibrillation vs stable angina pectoris, P = 0.017, for difference in medians. Reference Clin Chem 2012;58(3) CP
23 Reasons for Difficulty Calcuating the Proper Delta Value Problems with the gold standard diagnosis Flow dependence of release High sensitivity means small changes make big differences What metric is desired to optmize clinical performance; i.e. sensitivity vs specificity Spontaneous changes in those without AMI What to call those who have elevated hsctn but a less than significant defined delta? CP
24 MUST USE FIXED TIMING Near 99 th % URL value Delta Guidance The greater the change, the more likely AMI The lesser the change, the less likely AMI Percentages and absolute values may provide similar information At higher levels Absolute values may be better CP
25 Delta Guidance MUST USE FIXED TIMING Near 99 th % URL value At higher levels Avoid The greater the change, the more likely AMI The lesser the change, the less likely AMI Percentages and absolute values may provide similar information Absolute values may be better Extrapolating the data from one assay to another assay The idea that release is continuous so that one can use a one or 2 hour delta by dividing by the delta found at 5 or 6 hours. CP
26 It is not the Data but How You Intepret it that is Important CP
Does serial troponin measurement help identify acute ischemia/ischemic events?
Does serial troponin measurement help identify acute ischemia/ischemic events? Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine and Laboratory Medicine & Pathology
More information10 Ways to Make the Use of High Sensitivity Cardiac Troponin Values Easier and Better
10 Ways to Make the Use of High Sensitivity Cardiac Troponin Values Easier and Better Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department
More informationHigh Sensitivity Troponin Improves Management. But Not Yet
High Sensitivity Troponin Improves Management But Not Yet Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory Medicine
More informationUse of Biomarkers for Detection of Acute Myocardial Infarction
Use of Biomarkers for Detection of Acute Myocardial Infarction Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory Medicine
More informationTroponin when is an assay high sensitive?
Troponin when is an assay high sensitive? Professor P. O. Collinson MA MB BChir FRCPath FRCP edin MD FACB EurClin Chem Consultant Chemical Pathologist and Professor of Cardiovascular Biomarkers, Departments
More informationTroponin Assessment. Does it Carry Clinical Message? Stefan Blankenberg. University Heart Center Hamburg
Biomarkers for Optimal Management of Heart Failure Troponin Assessment Does it Carry Clinical Message? Stefan Blankenberg University Heart Center Hamburg Congress of the European Society of Cardiology
More informationHow will new high sensitive troponins affect the criteria?
How will new high sensitive troponins affect the criteria? Hugo A Katus MD Abteilung Innere Medizin III Kardiologie, Angiologie, Pulmologie Universitätsklinikum Heidelberg Even more sensitive: The new
More informationTROPONINS HAVE THEY CHANGED YOUR
TROPONINS HAVE THEY CHANGED YOUR PRACTICE THIS WEEK? Harvey White John Neutze Scholar Green Lane Cardiovascular Service and Cardiovascular Research Unit Auckland City Hospital, Auckland, New Zealand Disclosure
More informationMario Plebani University-Hospital of Padova, Italy
Mario Plebani University-Hospital of Padova, Italy CK-MB mass assay CHF guidelines use BNP for rule out AST in AMI CK in AMI INH for CK-MB electrophoresis for CK and LD isoenzymes RIA for myoglobin WHO
More informationBioRemarkable Symposium
BACC BioRemarkable Symposium Acute Myocardial infarction Stefan Blankenberg University Heart Center Hamburg London, September 7th, 2017 Universitätsklinikum Hamburg-Eppendorf Third Universal-Definition
More informationHigh-Sensitivity Cardiac Troponin in Suspected ACS
15 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes STATE-OF-THE-ART High-Sensitivity Cardiac Troponin in Suspected ACS David A. Morrow, MD, MPH Director, Levine Cardiac Intensive Care
More informationImpact of Troponin Performance on Patient Care
Impact of Troponin Performance on Patient Care Linda C, Rogers PhD, DABCC, FACB Agenda Introduction Diagnosis of MI Guidelines Troponin Assay differences Classification of troponin assays Guideline acceptable
More informationCardiac Troponin Testing and Chest Pain Patients: Exploring the Shades of Gray
Cardiac Troponin Testing and Chest Pain Patients: Exploring the Shades of Gray Nichole Korpi-Steiner, PhD, DABCC, FACB University of North Carolina Chapel Hill, NC Learning Objectives Describe the acute
More informationIFCC Task Force on Clinical Applications of Cardiac Biomarkers (TF-CB) Report to the General Conference 2016 Madrid
IFCC Task Force on Clinical Applications of Cardiac Biomarkers (TF-CB) Report to the General Conference 2016 Madrid 1 CREATED By the EB in 2011, following to the Committee on Standardization of Cardiac
More informationSupplementary Online Content
Supplementary Online Content Rubini Giménez M, Twerenbold R, Boeddinghaus J, et al. Clinical effect of sex-specific cutoff values of high-sensitivity cardiac troponin T in suspected myocardial infarction.
More informationPeri-operative Troponin Measurements - Pathophysiology and Prognosis
Peri-operative Troponin Measurements - Pathophysiology and Prognosis Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory
More informationHigh Sensitivity Troponins. IT S TIME TO SAVE LIVES. Updates from the ESC 2015 Guidelines November 17th 2016 OPL CONGRESS Dr.
High Sensitivity Troponins. IT S TIME TO SAVE LIVES. Updates from the ESC 2015 Guidelines November 17th 2016 OPL CONGRESS Dr. Marcel El Achkar Chairperson of Laboratory department Nini Hospital Lecturer
More informationTable. Analytical characteristics of commercial and research cardiac troponin I and T assays declared by the manufacturer.
Table. Analytical characteristics of commercial and research cardiac troponin I and T assays declared by the manufacturer. Commercially available assays - Company/ platform(s)/ assay LoB a LoD b 99 th
More informationThe Clinical Laboratory Working with Physicians to Improve Patient Care
The Clinical Laboratory Working with Physicians to Improve Patient Care Michael A. Pesce, PhD Professor Emeritus Columbia University Medical Center Department of Pathology and Cell Biology Objectives Troponin
More informationWaiting for High-Sensitivity POCT Cardiac Troponin Assays: Clinical and Analytical Needs I Have a Pain in My Chest That Hurts Very Bad
Waiting for High-Sensitivity POCT Cardiac Troponin Assays: Clinical and Analytical Needs I Have a Pain in My Chest That Hurts Very Bad Fred Apple PhD Hennepin County Medical Center University of Minnesota
More informationCARDIOLOGY GRAND ROUNDS
CARDIOLOGY GRAND ROUNDS Presentation: Speaker: Date: Location: Troponin State of the Art: Past, Present and Future Yader Sandoval, MD Cardiovascular Disease Fellow Minneapolis Heart Institute at Abbott
More informationÄr dagens troponinmetoder tillräckligt känsliga?
Är dagens troponinmetoder tillräckligt känsliga? Per Venge, MD PhD Professor Department of Medical Sciences Uppsala University and Department of Clinical Chemistry and Pharmacology University Hospital
More informationUndetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung, MD, PhD; Magnus Johansson, MD, PhD; Martin Holzmann,
More informationDocument Version Publisher s PDF, also known as Version of Record (includes final page, issue and volume numbers)
Variation of cardiac troponin I and T measured with sensitive assays in emergency department patients with noncardiac chest pain Scharnhorst, V.; Krasznai, K.; van 't Veer, M.; Michels, R.H. Published
More informationConference Paper Small Changes in Cardiac Troponin Levels Are Common in Patients with Myocardial Infarction: Diagnostic Implications
Conference Papers in Medicine, Article ID 583175, 5 pages http://dx.doi.org/10.1155/2013/583175 Conference Paper Small Changes in Cardiac Troponin Levels Are Common in Patients with Myocardial Infarction:
More informationBertil Lindahl Akademiska sjukhuset Uppsala
Bertil Lindahl Akademiska sjukhuset Uppsala Kriterier för akut hjärtinfarkt Bevis på myokardskada/nekros: Konstaterad höjning och/eller sänkning av biomarkörer (företrädesvis troponin) med minst ett värde
More informationUndetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung, MD, PhD; Magnus Johansson, MD, PhD; Martin Holzmann,
More informationWhat can we learn from EQAs and audits for cardiac marker testing?
What can we learn from EQAs and audits for cardiac marker testing? Dr P. O. Collinson MA MB BChir FRCPath MD FACB Consultant Chemical Pathologist and Director of Clinical Blood Sciences, Head of Vascular
More informationACCESS hstni SCIENTIFIC LITERATURE
ACCESS hstni SCIENTIFIC LITERATURE 2017 2018 Table of contents Performance Evaluation of Access hstni A critical evaluation of the Beckman Coulter Access hstni: Analytical performance, reference interval
More informationThe clinical performance of the novel POC Minicare ctni-assay. Per Venge, MD PhD Professor in Clinical Chemistry Uppsala University Uppsala, Sweden
The clinical performance of the novel POC Minicare ctni-assay Per Venge, MD PhD Professor in Clinical Chemistry Uppsala University Uppsala, Sweden Disclosure: Per Venge has received consultancy honoraria
More informationHigh-Sensitivity Cardiac Troponin T Concentrations below the Limit of Detection to Exclude Acute Myocardial Infarction: A Prospective Evaluation
Clinical Chemistry 61:7 983 989 (2015) Proteomics and Protein Markers High-Sensitivity Cardiac Troponin T Concentrations below the Limit of Detection to Exclude Acute Myocardial Infarction: A Prospective
More informationPost-Procedural Myocardial Injury or Infarction
Post-Procedural Myocardial Injury or Infarction Hugo A Katus MD & Evangelos Giannitsis MD Abteilung Innere Medizin III Kardiologie, Angiologie, Pulmologie Universitätsklinikum Heidelberg Conflict of Interest:
More informationValidation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain
Elevation of cardiac troponin (ctn) levels is central to the definition of acute myocardial infarction (AMI). 1 Increasingly sensitive ctn assays offer the potential for AMI to be diagnosed earlier than
More informationCongreso Nacional del Laboratorio Clínico 2016
Can biomarkers help us make a better use of cardiac imaging for myocardial ischaemia rule-out in the Emergency Department? Alessandro Sionis Director Acute and Intensive Cardiac Care Unit Hospital de la
More informationCase Studies Using hsctn Assays. A Joint AACC ACC symposium Fred Apple Ph.D. Chris DeFlippi M.D. Allan S. Jaffe, M.D.
35105 - Case Studies Using hsctn Assays A Joint AACC ACC symposium Fred Apple Ph.D. Chris DeFlippi M.D. Allan S. Jaffe, M.D. Case Study: Defining Gender Specific 99 th Percentiles for High Sensitivity
More informationImproving the detection of myocardial infarction in women
Improving the detection of myocardial infarction in women British Cardiac Society Listening to the Female Voice 4 th June 2014 anoopsshah@gmail.com Dr Anoop Shah BHF Centre for Cardiovascular Sciences
More informationHigh-sensitivity Troponin T Predicts Recurrent Cardiovascular Events in Patients with Stable Coronary Heart Disease: KAROLA Study 8 Year FU
ESC Congress 2011 Paris, France, August 27-31 KAROLA Session: Prevention: Are biomarkers worth their money? Abstract # 84698 High-sensitivity Troponin T Predicts Recurrent Cardiovascular Events in Patients
More informationEDUCATIONAL COMMENTARY UNDERSTANDING THE BENEFITS AND CHALLENGES OF HIGH- SENSITIVITY TROPONIN TESTING IN CLINICAL AND PATHOLOGY SETTINGS
SENSITIVITY TROPONIN TESTING IN CLINICAL AND PATHOLOGY SETTINGS Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationRapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay
Original Article Annals of Clinical Biochemistry 2015, Vol. 52(5) 543 549! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalspermissions.nav DOI: 10.1177/0004563215576976 acb.sagepub.com
More informationPreparing the United States for High-Sensitivity Cardiac Troponin Assays
Journal of the American College of Cardiology Vol. 61, No. 17, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.09.069
More information7/31/2018. Overview of Next Generation Cardiac Troponin T High Sensitivity. Disclosures. Course Objectives: high sensitive Troponin T assay
Overview of Next Generation Cardiac Troponin T High Sensitivity Arleen Francis Medical & Scientific Liaison Roche Diagnostics 1 Disclosures Arleen Francis is an employee of Roche Diagnostics and a member
More informationHit the road Jack! W. FRANK PEACOCK, MD, FACEP, FACC
Hit the road Jack! W. FRANK PEACOCK, MD, FACEP, FACC Visits 130,000,000 annually 10.4 M chest pain (8.0%) 4.1 M sent home non-cardiac 6.24 M suspected or actual cardiac 50,000 MIs 3.1 M non-cardiac (50%)
More informationTitle:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke
Author's response to reviews Title:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke Authors: Kashif W Faiz (kashif.faiz@medisin.uio.no) Bente Thommessen (bente.thommessen@ahus.no)
More informationRapid rule out of acute myocardial infarction: novel biomarker-based strategies
653229ACC0010.1177/2048872616653229European Heart Journal: Acute Cardiovascular CareMueller et al. research-article2016 Original scientific paper Rapid rule out of acute myocardial infarction: novel biomarker-based
More informationDIAGNOSTICS ASSESSMENT PROGRAMME
DIAGNOSTICS ASSESSMENT PROGRAMME Evidence overview Early rule out or diagnosis of acute myocardial infarction: High-sensitivity troponin tests (Elecsys troponin T high-sensitive, ARCHITECT STAT highsensitivity
More informationRapid detection of myocardial infarction with a sensitive troponin test Scharnhorst, V.; Krasznai, K.; van 't Veer, M.; Michels, R.
Rapid detection of myocardial infarction with a sensitive troponin test Scharnhorst, V.; Krasznai, K.; van 't Veer, M.; Michels, R. Published in: American Journal of Clinical Pathology DOI: 10.1309/AJCPA4G8AQOYEKLD
More informationhs-c Tn I high sensitivity troponin I <17 min
hs-c Tn I high sensitivity troponin I IFCC & ESC compliant 0/ h NSTEMI rule-out / rule-in algorithm POCT whole blood/plasma Results in < 7 minutes
More informationAssays Pros and Cons AACB 2013 GOLD COAST QUEENSLAND AUSTRALIA
Highly Sensitive Versus Sensitive Troponin Assays Pros and Cons AACB 2013 GOLD COAST QUEENSLAND AUSTRALIA Robert H. Christenson, Ph.D., DABCC, FACB 2013 AACC President Professor of Pathology Professor
More informationEDUCATIONAL COMMENTARY CARDIAC FUNCTION: BIOCHEMICAL MARKERS UPDATE
EDUCATIONAL COMMENTARY CARDIAC FUNCTION: BIOCHEMICAL MARKERS UPDATE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationClinical Application of Cardiac Biomarkers in an Accredited Chest Pain Center Laboratory s Best Practices
Clinical Application of Cardiac Biomarkers in an Accredited Chest Pain Center Laboratory s Best Practices Noemi Melendres-Wozny, BSN., RN Accreditation Review Specialist National Client Relations Manager
More informationSpeaker: Richard Heitsman, MICT, C-POC-AACC. Title: National Account Manager/Clinical Cardiac Specialist-Radiometer America.
Speaker: Richard Heitsman, MICT, C-POC-AACC Title: National Account Manager/Clinical Cardiac Specialist-Radiometer America. Upon completion the participant will be able to o Review current and evolving
More informationCardiac Troponin Assays: Guide to Understanding Analytical Characteristics and Their Impact on Clinical Care
Clinical Chemistry 63:1 73 81 (2017) Mini-Reviews Cardiac Troponin Assays: Guide to Understanding Analytical Characteristics and Their Impact on Clinical Care Fred S. Apple, 1* Yader Sandoval, 2 Allan
More informationSerial Changes in Highly Sensitive Troponin I Assay and Early Diagnosis of Myocardial Infarction JAMA. 2011;306(24):
ORIGINAL CONTRIBUTION Serial Changes in Highly Sensitive Troponin I Assay and Early Diagnosis of Myocardial Infarction Till Keller, MD Tanja Zeller, PhD Francisco Ojeda, PhD Stergios Tzikas, MD Lars Lillpopp
More informationFifty shades of Troponin. Dr Liam Penny The Queens Hotel, Cheltenham 4 th October 2012
Fifty shades of Troponin Dr Liam Penny The Queens Hotel, Cheltenham 4 th October 2012 Plaque-fissure and intracoronary thrombus Courtesy Prof. MJ Davies Acute Coronary Syndromes Plaque-fissure and intracoronary
More informationDolore Toracico e Livelli di Troponina non Misurabili
Dolore Toracico e Livelli di Troponina non Misurabili Andrea Fabbri Dipartimento di Emergenza Presidio Ospedaliero Morgagni Pierantoni Azienda USL Romagna Forlì andrea.fabbri@auslromagna.it Rapid Exclusion
More informationImpact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction
doi: 10.2169/internalmedicine.8510-16 http://internmed.jp ORIGINAL ARTICLE Impact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction Taro Ichise, Hayato
More informationCardiac Troponin: Current Status and Future Promise
Cardiac Troponin: Current Status and Future Promise Robert H. Christenson, Ph.D., ABCC, FACB Professor of Pathology Professor of Medical and Research Technology University of Maryland School of Medicine
More informationHigh-sensitivity cardiac troponin I immunoassay reduces the chance of patient misclassification in the emergency department
Original Article Page 1 of 5 High-sensitivity cardiac troponin I immunoassay reduces the chance of patient misclassification in the emergency department Giuseppe Lippi 1, Fabian Sanchis-Gomar 2,3,4, Rosalia
More informationInternational Journal of Cardiology and Cardiovascular Research Vol. 4(2), pp , September, ISSN:
International Journal of Cardiology and Cardiovascular Research Vol. 4(2), pp. 072-078, September, 2018. www.premierpublishers.org, ISSN: 3102-9869 IJCCR Research Article Copeptin as a Novel Biomarker
More informationSupplementary Online Content
Supplementary Online Content McEvoy JW, Chen Y, Ndumele CE, et al. Six-year change in high-sensitivity cardiac troponin T and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol.
More informationEARLY DIAGNOSIS AND RISK STRATIFICATION IN PATIENTS WITH SYMPTOMS SUGGESTIVE OF ACUTE CORONARY SYNDROME
DEPARTMENT OF CLINICAL SCIENCE AND EDUCATION, SÖDERSJUKHUSET Karolinska Institutet, Stockholm, Sweden EARLY DIAGNOSIS AND RISK STRATIFICATION IN PATIENTS WITH SYMPTOMS SUGGESTIVE OF ACUTE CORONARY SYNDROME
More informationEvaluation of the optimal myocardial infarction cutoff for the PATHFAST Troponin I assay of Mitsubishi Kagaku Iatron (MKI)
Evaluation of the optimal myocardial infarction cutoff for the PATHFAST Troponin I assay of Mitsubishi Kagaku Iatron (MKI) Principal Investigator: Priv. Doz. Dr. med Dirk Peetz Institute of Clinical Chemistry
More informationRecent community campaigns on
Availability of highly sensitive troponin assays and acute coronary syndrome care: insights from the SNAPSHOT registry Use of hs troponin testing of patients hospitalised with possible ACS was associated
More informationThe state-of-the-art of high-sensitivity immunoassay for measuring cardiac troponin I and T
Editorial Page 1 of 5 The state-of-the-art of high-sensitivity immunoassay for measuring cardiac troponin I and T Aldo Clerico 1, Giuseppe Lippi 2 1 Scuola Superiore Sant Anna and Fondazione CNR Regione
More informationPerformance of the high-sensitivity troponin assay in diagnosing acute myocardial infarction: systematic review and meta-analysis
Performance of the high-sensitivity troponin assay in diagnosing acute myocardial infarction: systematic review and meta-analysis Ayman Al-Saleh MD, Ashraf Alazzoni MD, Saleh Al Shalash MD, Chenglin Ye
More informationRESPONSES TO COMMENTS ON: Recommendations for Use of Point-of-Care (POC) Troponin Assays in Assessment of Acute Coronary Syndrome
RESPONSES TO COMMENTS ON: Recommendations for Use of Point-of-Care (POC) Troponin Assays in Assessment of Acute Coronary Syndrome Page 1 Responses were received from: 1. Chemical Pathology Clinical Stream,
More informationLow concentrations of high-sensitivity troponin T at presentation to the
Title Page Low concentrations of high-sensitivity troponin T at presentation to the Emergency Department. Running head: Early rule-out using high-sensitivity troponin T Article Type: Letter to the Editor
More informationBiomarkers in Heart Disease. Felix J. Rogers, DO, FACOI April 29, 2018
Biomarkers in Heart Disease Felix J. Rogers, DO, FACOI April 29, 2018 Biomarkers NIH: A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes,
More informationThe patient with 30 min chest pain presenting at the ER two hours after onset of symptoms. Professor Christian Mueller
The patient with 30 min chest pain presenting at the ER two hours after onset of symptoms Professor Christian Mueller Disclosures Swiss National Science Foundation.... Research support / travel support
More informationPerioperative Myocardial Infarction
Perioperative Myocardial Infarction Which patient should UNDERGO CORONARY ANGIOGRAPHY? The Cardiologists view Hans Rickli, St.Gallen 1 Experience Standards Risk stratification Team approach.. Tightrope
More informationEvaluating Rapid Rule-out of Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay at Presentation
Clinical Chemistry 64:5 820 829 (2018) Proteomics and Protein Markers Evaluating Rapid Rule-out of Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay at Presentation Jaimi Greenslade,
More informationClinical Investigations
Clinical Investigations Prognostic Implications of Low Level Cardiac Troponin Elevation Using High-Sensitivity Cardiac Troponin T Address for correspondence: Marc P. Bonaca, MD TIMI Study Group/Cardiovascular
More informationTrial to Reduce. Aranesp* Therapy. Cardiovascular Events with
Trial to Reduce Cardiovascular Events with Aranesp* Therapy John J.V. McMurray, Hajime Uno, Petr Jarolim, Akshay S. Desai, Dick de Zeeuw, Kai-Uwe Eckardt, Peter Ivanovich, Andrew S. Levey, Eldrin F. Lewis,
More informationIntroduction. Review. Petr Jarolim* High sensitivity cardiac troponin assays in the clinical laboratories
Clin Chem Lab Med 2015; 53(5): 635 652 Review Petr Jarolim* High sensitivity cardiac troponin assays in the clinical laboratories DOI 10.1515/cclm-2014-0565 Received May 27, 2014; accepted July 24, 2014;
More informationCurrent Utilities of Cardiac Biomarker Testing at POC. June 24, 2010 Joe Pezzuto, MT (ASCP) Carolyn Kite, RN
Current Utilities of Cardiac Biomarker Testing at POC June 24, 2010 Joe Pezzuto, MT (ASCP) Carolyn Kite, RN 1. Discuss challenges associated with diagnosing Acute Coronary Syndromes (ACS) and Heart Failure
More informationDiagnostic and prognostic significance of high sensitive troponin in chest pain
European Review for Medical and Pharmacological Sciences Diagnostic and prognostic significance of high sensitive troponin in chest pain I. CASAGRANDA, E.C. LAURITANO Emergency Department, SS. Antonio
More informationAcute Coronary Syndromes
High-sensitivity Troponins Difficult Friends in Acute Coronary Syndromes Roland Klingenberg, Christian M Matter, 2 Christophe Wyss, Danielle Hof, Arnold von Eckardstein and Thomas F Lüscher 6. Clinical
More informationNew diagnostic markers for acute coronary syndromes
New diagnostic markers for acute coronary syndromes - Nye diagnostiske markørerer for akutt iskemisk hjertesykdom Bertil Lindahl, Professor Cardiology, Uppsala University and Uppsala Clinical Research
More informationDECLARATION OF CONFLICT OF INTEREST. None
DECLARATION OF CONFLICT OF INTEREST None Controversies on marathon and beyond: Elevated biomarkers as a proof of cardiac damage: Contra Jürgen Scharhag, FACSM, FESC Internal Medicine III: Cardiology, Angiology
More informationHigh-sensitivity cardiac troponin and the under diagnosis of myocardial infarction in women: a prospective cohort study
DATA SUPPLEMENT High-sensitivity cardiac troponin and the under diagnosis of myocardial infarction in women: a prospective cohort study Anoop SV Shah, 1 Megan Griffiths, 1 Kuan Ken Lee, 1 David A McAllister,
More informationSupplemental Material
Supplemental Material Table of Contents Supplemental Methods... 2 Details on exclusion criteria... 2 Use of hs-ctnt for adjudication of final diagnoses... 2 Assumption of Linearity... 3 Investigational
More informationChest pain and troponins on the acute take. J N Townend Queen Elizabeth Hospital Birmingham
Chest pain and troponins on the acute take J N Townend Queen Elizabeth Hospital Birmingham 3 rd Universal Definition of Myocardial Infarction Type 1: Spontaneous MI related to atherosclerotic plaque rupture
More informationTroponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy. Ziad Hijazi, MD
Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy Ziad Hijazi, MD Uppsala Clinical Research Center (UCR) Uppsala University, Sweden Co-authors:
More informationAbstract. Introduction. imedpub Journals
Research Article imedpub Journals www.imedpub.com DOI: 10.21767/2472-1646.100056 Could the Intra-Laboratory Inter-Identical- Instrument Bias Compromise the Interpretation of the Absolute High-Sensitive
More informationTITLE: Cardiac Troponin for the Diagnosis of Acute Coronary Syndrome in the Emergency Department: A Review of Guidelines
TITLE: Cardiac Troponin for the Diagnosis of Acute Coronary Syndrome in the Emergency Department: A Review of Guidelines DATE: 11 January 2013 CONTEXT AND POLICY ISSUES Cardiac troponin (ctn) is a cardiomyocyte-specific
More informationCanadian Agency for Drugs and Technologies in Health. Agence canadienne des médicaments et des technologies de la santé. Supporting Informed Decisions
Canadian Agency for Drugs and Technologies in Health Agence canadienne des médicaments et des technologies de la santé CADTH Optimal Use Report March 2013 Volume 2, Issue 1B Recommendations for the Use
More informationCirculating mir-499 are novel and sensitive biomarker of acute myocardial infarction
Original Article Circulating mir-499 are novel and sensitive biomarker of acute myocardial infarction Lizhu Zhang 1 *, Xi Chen 1 *, Tong Su 1, Heng Li 1, Qiang Huang 1, Dan Wu 1, Chengjian Yang 1, Zhijun
More informationTitle:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke
Author's response to reviews Title:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke Authors: Kashif W Faiz (kashif.faiz@medisin.uio.no) Bente Thommessen (bente.thommessen@ahus.no)
More informationKeywords Troponin (I and T), high sensitive, gastro-intestinal, abdominal surgery, goal-directed therapy
Original Article Annals of Clinical Biochemistry 2014, Vol. 51(2) 258 268! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalspermissions.nav DOI: 10.1177/0004563213494078 acb.sagepub.com
More information9/18/2017. Disclosures. Cardiac Troponin: ER Utilization and the Next Generation
Disclosures Cardiac Troponin: ER Utilization and the Next Generation Joshua Soldo is an employee of Roche Diagnostics within the division of Medical Scientific Affairs. Data presented is intended for purely
More informationWeekly and 90-Minute Biological Variations in Cardiac Troponin T and Cardiac Troponin I in Hemodialysis Patients and Healthy Controls
Papers in Press. Published March 11, 2014 as doi:10.1373/clinchem.2013.216978 The latest version is at http://hwmaint.clinchem.org/cgi/doi/10.1373/clinchem.2013.216978 Clinical Chemistry 60:6 000 000 (2014)
More informationMyocardial Injury after Noncardiac Surgery (MINS): What is it and what can we do to help patients suffering this event? PJ Devereaux, MD, PhD
Myocardial Injury after Noncardiac Surgery (MINS): What is it and what can we do to help patients suffering this event? PJ Devereaux, MD, PhD Disclosure Member of research group with policy of not accepting
More informationThe PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque
The PROSPECT Trial Providing Regional Observations to Study Predictors of Events in the Coronary Tree A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively
More informationORIGINAL ARTICLE Determination of the 99th percentile upper reference limit for highsensitivity cardiac troponin I in Malaysian population
Malaysian J Pathol 2017; 39(2) : 135 140 ORIGINAL ARTICLE Determination of the 99th percentile upper reference limit for highsensitivity cardiac troponin I in Malaysian population Say Min LIM MD, Subashini
More informationCCS Perioperative Guidelines When to order a BNP and What to do with a Positive Troponin
Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON CCS Perioperative Guidelines When to order a BNP and What to do with a Positive Troponin Dr. Vikas Tandon Associate Professor, Cardiology
More informationEffective Health Care Program
Comparative Effectiveness Review Number 135 Effective Health Care Program Cardiac Troponins Used as Diagnostic and Prognostic Tests in Patients With Kidney Disease Executive Summary Background Cardiac
More informationHeart-type fatty acid-binding protein in early diagnosis of acute myocardial infarction in comparison to sensitive troponin I
Heart-type fatty acid-binding protein in early diagnosis of acute myocardial infarction in comparison to sensitive troponin I E. Czyz 1, S. Tzikas 1, A. Schulz 1, T. Zeller 1,3, S. Baldus 3, C. Bickel
More informationLearning Objectives. Predicting and Preventing Cardiovascular Disease. ACC/AHA Cholesterol Guidelines Key differences vs ATP III
Presenter Disclosure Information 10:30 11:15am Predicting and Preventing Cardiovascular Disease: Can we put the Cardiologist out of business? The following relationships exist related to this presentation:
More informationCLINICAL GUIDANCE FRAMEWORKS
IMPROVING CARE PROCESSES FOR PATIENTS WITH POSSIBLE SUSPECTED ACUTE CORONARY SYNDROME (ICARE-ACS): A NATIONAL IMPLEMENTATION TRIAL OF A CLINICAL GUIDANCE FRAMEWORK S Aldous; on behalf of the IcareACS team
More informationGSK Medicine: Study Number: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More information