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

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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'''.
 
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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''NOTE:  The information below is not a guideline, but rather excerpts and links intended to augment and/or help develop clinical judgement.''
 
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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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A 0h-1h delta (i.e. a change over one hour, 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>
 
Per the ACC white paper (see below):<br>
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[[File:UTSW-Parkland hs-cTnT pathway.PNG|1000px]]
 
[[File:UTSW-Parkland hs-cTnT pathway.PNG|1000px]]
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Note that this algorithm does not include risk stratification, such as with the HEART score.  Other algorithms separate out Hs-cTnT and call the risk stratification a HEAR score (or modified-HEART score) and guide diagnosis/management based upon different combinations of Hs-cTnT and HEAR values.
 
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Revision as of 05:43, 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.

NOTE: The information below is not a guideline, but rather excerpts and links intended to augment and/or help develop clinical judgement.




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 0h-1h delta (i.e. a change over one hour, 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 somewhat similar algorithms on reputable medical sites. In particular, the ACEP Webinar (see below, page 16) displays the following diagnostic algorithm:

UTSW-Parkland hs-cTnT pathway.PNG

Note that this algorithm does not include risk stratification, such as with the HEART score. Other algorithms separate out Hs-cTnT and call the risk stratification a HEAR score (or modified-HEART score) and guide diagnosis/management based upon different combinations of Hs-cTnT and HEAR values.

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