High-sensitivity Troponin-T: Difference between revisions
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== Diagnostic Algorithm == | == 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: | 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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Revision as of 11:50, 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