Difference between revisions of "High-sensitivity Troponin-T"

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(Created page with "The U.S. FDA approved the first high-sensitivity troponin assay on _. YKDHR adopted the high-sensitivity troponin-T assay (by ''Roche Diagnostics'') on November 12, 2019.")
 
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The U.S. FDA approved the first high-sensitivity troponin assay on _.
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The U.S. FDA approved the first high-sensitivity troponin assay, the Roche Diagnostics ''Elecsys Troponin T (TnT) Gen 5 Stat'' test, in March 2017.
  
YKDHR adopted the high-sensitivity troponin-T assay (by ''Roche Diagnostics'') on November 12, 2019.
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Yukon-Kuskokwim Delta Regional Hospital (YKDHR) adopted this high-sensitivity cardiac troponin-T (Hs-cTnT) assay on November 12, 2019.
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The high-sensitivity and contemporary troponin-T assays can be distinguished by the units in which they are reported:  Hs-cTnT is reported in ng/'''L''' whereas the contemporary assay (cTnT) is reported in ng/'''mL'''.
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<br>
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<br>
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<br>
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__TOC__
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<br>
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<br>
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== Cutoffs ==
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Hs-cTnT is considered "positive" when above the gender-specific 99th percentile URL (upper reference range).  Per eMail from Scott Cox (YKDHR Director of Diagnostic Services) on 11/10/2019, the following cutoff are recommended for our assay:
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{| class="wikitable" style="margin: auto;"
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|+Positive Values
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|-
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| Women    || >= '''14''' ng/L
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|-
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| Men || >= '''22''' ng/L
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|}
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<br>
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A delta (i.e. a change over time, either increase or decrease) >= '''3''' ng/L is considered positive for acute myocardial injury (AMI).<br>
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<br>
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Per the ACC white paper (see below):<br>
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* A single Hs-cTnT >= '''100''' ng/L is diagnostic of AMI (in the appropriate clinical context).<br>
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* When chest pain has been present for >= 2 hours, a single Hs-cTnT < '''6''' ng/L has been reported to rule out AMI with essentially 100% negative predictive value.
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<br>
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== Diagnostic Algorithm ==
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Currently there are no experimentally validated diagnostic algorithms using Hs-cTnT.  However, the internet contains several similar algorithms on reputable sites.  In particular, the ACEP Webinar (see below, page 16) displays the following diagnostic algorithm:
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<br>
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== Helpful Links ==
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'''ACC (American College of Cardiology)'''
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:[https://www.acc.org/latest-in-cardiology/articles/2018/07/16/09/17/high-sensitivity-cardiac-troponin-in-the-evaluation-of-possible-ami ''High-Sensitivity Cardiac Troponin in the Evaluation of Possible AMI'' (July 16, 2018)]
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:[https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/08/24/00/09/fourth-universal-definition-of-mi-esc-2018 ''SUMMARY: Fourth Universal Definition of Myocardial Infarction'' (Aug 25, 2018)]
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<br>
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'''ACEP'''
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:[https://www.acep.org/globalassets/sites/acep/media/equal-documents/webinar_chestpainw3_hsctn2.pdf ''Webinar: Incorporating High-Sensitivity Troponin into Your ED'']
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<br>
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'''MD Calc'''
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:[https://www.mdcalc.com/heart-score-major-cardiac-events HEART Score for Major Cardiac Events]
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<br>

Revision as of 03:43, 2 December 2019

The U.S. FDA approved the first high-sensitivity troponin assay, the Roche Diagnostics Elecsys Troponin T (TnT) Gen 5 Stat test, in March 2017.

Yukon-Kuskokwim Delta Regional Hospital (YKDHR) adopted this high-sensitivity cardiac troponin-T (Hs-cTnT) assay on November 12, 2019.

The high-sensitivity and contemporary troponin-T assays can be distinguished by the units in which they are reported: Hs-cTnT is reported in ng/L whereas the contemporary assay (cTnT) is reported in ng/mL.




Cutoffs

Hs-cTnT is considered "positive" when above the gender-specific 99th percentile URL (upper reference range). Per eMail from Scott Cox (YKDHR Director of Diagnostic Services) on 11/10/2019, the following cutoff are recommended for our assay:

Positive Values
Women >= 14 ng/L
Men >= 22 ng/L


A delta (i.e. a change over time, either increase or decrease) >= 3 ng/L is considered positive for acute myocardial injury (AMI).

Per the ACC white paper (see below):

  • A single Hs-cTnT >= 100 ng/L is diagnostic of AMI (in the appropriate clinical context).
  • When chest pain has been present for >= 2 hours, a single Hs-cTnT < 6 ng/L has been reported to rule out AMI with essentially 100% negative predictive value.


Diagnostic Algorithm

Currently there are no experimentally validated diagnostic algorithms using Hs-cTnT. However, the internet contains several similar algorithms on reputable sites. In particular, the ACEP Webinar (see below, page 16) displays the following diagnostic algorithm:



Helpful Links

ACC (American College of Cardiology)

High-Sensitivity Cardiac Troponin in the Evaluation of Possible AMI (July 16, 2018)
SUMMARY: Fourth Universal Definition of Myocardial Infarction (Aug 25, 2018)


ACEP

Webinar: Incorporating High-Sensitivity Troponin into Your ED


MD Calc

HEART Score for Major Cardiac Events