High-sensitivity Troponin-T: Difference between revisions
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The U.S. FDA approved the first high-sensitivity troponin assay | 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 | 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'''. | |||
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__TOC__ | |||
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== 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: | |||
{| class="wikitable" style="margin: auto;" | |||
|+Positive Values | |||
|- | |||
| Women || >= '''14''' ng/L | |||
|- | |||
| Men || >= '''22''' ng/L | |||
|} | |||
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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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Per the ACC white paper (see below):<br> | |||
* A single Hs-cTnT >= '''100''' ng/L is diagnostic of AMI (in the appropriate clinical context).<br> | |||
* 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. | |||
<br> | |||
== 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: | |||
<br> | |||
== Helpful Links == | |||
'''ACC (American College of Cardiology)''' | |||
:[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)] | |||
:[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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'''ACEP''' | |||
:[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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'''MD Calc''' | |||
:[https://www.mdcalc.com/heart-score-major-cardiac-events HEART Score for Major Cardiac Events] | |||
<br> | |||
Revision as of 11:43, 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:
| 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
MD Calc
