How easy is it to switch between two different troponin assays?
Authors:
A. Jabor 1,2; T. Vacková 1,4; J. Kettner 3; A. Zárubová 1; D. Viczénová 1,2; J. Čásenská 1,4; J. Franeková 1,2
Authors place of work:
Oddělení klinické biochemie, Pracoviště laboratorních metod, Institut klinické a experimentální medicíny, Praha
1; Ústav imunologie a klinické biochemie, 3. lékařská fakulta Univerzity Karlovy, Praha
2; Klinika kardiologie, Kardiocentrum, Institut klinické a experimentální medicíny, Praha
3; 3. lékařská fakulta Univerzity Karlovy, Praha
4
Published in the journal:
Klin. Biochem. Metab., 30, 2022, No. 4, p. 117-124
Summary
Objective: To assess the limitations of intended change from one type of high sensitivity (hs) cardiac troponin (cTn) to another (hs-cTnT and hs-cTnI) in a real clinical setting.
Design: An observation study
Settings: Acute emergency unit, Cardiology department, Institute for clinical and experimental medicine (IKEM), Praha.
Material and Methods: Parallel testing of hs-cTnT (Cobas, Roche) and hs-cTnI (Architect, Abbott) in 567 consecutive patients of cardiology emergency. Method comparison (Passing-Bablok), calculation of time interval between sampling, assessment of delta concentration between two consecutive concentrations of hs-cTn, and comparison of classification. The time intervals between two consecutive samples were sorted into tertiles, and delta concentration was evaluated for the time interval up to 6 hours. A classification of the agreement for rule-in and rule-out diagnostics was evaluated according to the ESC Guidelines 2020 (kappa statistics).
Results: There were 821 pairs of hs-cTnT and hs-cTnI results. Passing-Bablok test revealed a slope of 3.07 (95% CI 2.77- 3.40), an intercept of -30.1 (95% CI -3.9 to -25.0), the equation was hs-cTnI = -30.4 + 3.07 * hs-cTnT, r= 0.934, p<0.001. The delta concentrations in the 1st tertile (42-65 min), 2nd tertile (66-112 min), and 3rd tertile (115-359 min) were (median and IQR) 3.3 (1.5-5.7); 2.6 (1.3-4.5); 48.5 (3.7-172.7) ng/L for hs-cTnT and 1.4 (0.4-2.9); 1.6 (0.6-9.5); 57.8 (5.5-755.9) ng/L for hs-cTnI. The classification agreement between hs-cTnT and hs-cTnI (ESC 1hour algorithm) was 63 % (kappa 0.425) and 77 % (kappa 0.716) for ESC 2-hour algorithm). The comparison of rule-in and rule-out classification revealed up- and down classification both for hs-cTnT and hs-cTnI.
Conclusion: A relationship between hs-cTnT and hs-cTnI exists, however, recalculation is impossible. A study revealed a low adherence to the recommended diagnostic algorithms with very high variability in the time intervals between sampling. The delta concentration of hs-cTnT is lower than the delta concentration of hs-cTnI for a shorter interval between samples, and vice versa, the delta concentration of hs-cTnI is higher with the longer time interval between samples. The classification agreement between hs-cTnT and hs-cTnI was moderate for the ESC 1-hour algorithm and suitable for the ESC 2hour algorithm. Switching from one type of high-sensitivity cardiac troponin to another is not trivial, and real data analysis, clinical assessment, and communication with clinicians is required.
Keywords:
troponin T – troponin I – acute myocardial infarction – diagnostic algorithm – guideline adherence
Zdroje
1. Kettner J. Akutní koronární syndrom bez přetrvávajících elevací úseku ST; In: Akutní kardiologie, 3.vydání, Grada Publishing, 2021, s.117.
2. Engliš, M, Šochman, J., Pudil, R, Franeková, J., Jabor, A.: High-sensitivity metody stanovení srdečních troponinů 2009: klinický potenciál, současná praxe a přínos, perspektiva. Vnitř. Lék., 55, 2009, 11, s. 1079 – 1084.
3. Apple FS, Sandoval Y, Jaffe AS, Ordonez-Llanos J; IFCC Task Force on Clinical Applications of Cardiac Bio-Markers. Cardiac Troponin Assays: Guide to Understanding Analytical Characteristics and Their Impact on Clinical Care. Clin Chem., 2017, 63(1), s. 73- 81. doi: 10.1373/clinchem.2016.255109. Epub 2016 Oct 10. PMID: 28062612.
4. Hammarsten O, Mair J, Möckel M, Lindahl B, Jaffe AS. Possible mechanisms behind cardiac troponin elevations. Biomarkers, 2018, 23(8), s. 725-734. doi: 10.1080/1354750X.2018.1490969. Epub 2018 Aug 23. PMID: 29976112.
5. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D; ESC Committee for Practice Guidelines. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J., 2011, 32(23), s. 2999-3054.
6. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent STsegment elevation. Eur Heart J., 2021, 42(14), s. 1289- 1367.
7. Abu Sharar H, Wohlleben D, Vafaie M, Kristen AV, Volz HC, Bekeredjian R, Katus HA, Giannitsis E. Coronary angiography-related myocardial injury as detected by high-sensitivity cardiac troponin T assay. EuroIntervention, 2016, 12(3), s. 337-44.
8. Jabor A., Kubíček Z., Komrsková J., Labanczová M., Vacková T., Vaingátová S., Viczénová D., Vymětalík J., Franeková J. Porovnání výsledků vysoce senzitivních stanovení troponinů I (Abbott, Beckman Coulter, Siemens) a troponinu T (Roche). Klin. Biochem. Metab., 2019, 27(48), 2, s. 53 – 60.
9. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/ American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. J Am. Coll. Cardiol., 2018, 72(18), s. 2231-2264.
10. Friedecký, B., Jabor, A., Kratochvíla, J., Rajdl, D., Kettner, J., Franeková, J., Janota, T., Pudil, R., Hnátek, T., Rokyta, R.: Doporučení ČSKB: Používání kardiálních troponinů při podezření na akutní koronární syndrom. Klin. Biochem. Metab., 2015, 23(44), 2, s. 71- 77.
11. Kimenai DM, Shah ASV, McAllister DA, Lee KK, Tsanas A, Meex SJR, Porteous DJ, Hayward C, Campbell A, Sattar N, Mills NL, Welsh P. Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population. Clin. Chem., 2021, 67(10), s. 1351-1360.
12. Collinson P, Suvisaari J, Aakre KM, Baum H, Duff CJ, Gruson D, Hammerer-Lercher A, Pulkki K, Stankovic S, Langlois MR, Apple FS, Laitinen P; EFLM Task Group on Cardiac Markers. How Well Do Laboratories Adhere to Recommended Guidelines for Cardiac Biomarkers Management in Europe? The CArdiac MARker Guideline Uptake in Europe (CAMARGUE) Study of the European Federation of Laboratory Medicine Task Group on Cardiac Markers. Clin Chem., 2021, 67(8), s. 1144-1152.
13. Liu L, Consagra W, Cai X, Mathias A, Worster A, Ma J, Rock P, Kwong T, Kavsak PA. Sex-Specific Absolute Delta Thresholds for High-Sensitivity Cardiac Troponin T. Clin Chem., 2022, 68(3), s. 441-449.
14. Franeková, J., Bláha, M., Bělohoubek, J., Kotrbatá, M., Sečník, P. Jr., Kubíček, Z., Kettner, J., Jabor, A.: A clinical and laboratory approach used to elucidate discordant results of high-sensitivity troponin T and troponin I. Clin Chim Acta, 446, 2015, s. 128-131.
15. Jabor, A., Franeková, J., Kubíček Z. Principy interpretace laboratorních testů. 2. přepracované a doplněné vydání. GRADA Publishing a.s., Praha, 2020. 456 s. ISBN 978-80-271-1272-2.
16. Giannitsis E, Mueller C, Katus HA. Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations. Diagnosis (Berl). 2019, 6(3), s. 189-201. doi: 10.1515/dx-2019-0045. PMID: 31271552.
17. Schmid J, Liesinger L, Birner-Gruenberger R, Stojakovic T, Scharnagl H, Dieplinger B, Asslaber M, Radl R, Beer M, Polacin M, Mair J, Szolar D, Berghold A, Quasthoff S, Binder JS, Rainer PP. Elevated Cardiac Troponin T in Patients With Skeletal Myopathies. J Am. Coll. Cardiol., 2018, 71(14), s. 1540-1549. doi: 10.1016/j.jacc.2018.01.070. PMID: 29622161.
Štítky
Clinical biochemistry Nuclear medicine Nutritive therapistČlánok vyšiel v časopise
Clinical Biochemistry and Metabolism
2022 Číslo 4
Najčítanejšie v tomto čísle
- Serum amyloid A and its clinical significance
- 14-3-3 proteins and their clinical significance
- Determination of chlorides in serum by methods with ion-selective electrodes (ISE). Standardization without harmonization.
- Budoucnost KBM od č.1/2023