Eprints.soton.ac.uk
High sensitivity troponins in contemporary cardiology practice: Are we turning a corner?Mark Mariathas1,2 BM, Bartosz Olechowski1,2 MD, Michael Mahmoudi1,2 MBBS, PhD, Nick Curzen1,2 BM(Hons), PhD *1Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK 2Faculty of Medicine, University of Southampton, Southampton, UKKeywordsTroponin, High sensitivity troponin, myocardial infarction, acute coronary syndromes, type 2 myocardial infarction, type 1 myocardial infarctionWord Count5664Funding: None*corresponding authorProf. N Curzen BM(Hons) PhD FRCPProfessor of Interventional CardiologyE Level North WingUniversity Hospital Southampton NHS TrustTremona RoadSouthampton SO16 6YDUK00442381204972nick.curzen@uhs.nhs.ukCompeting interests:M. Mariathas, B. Olechowski, M. Mahmoudi – none declaredN. Curzen – unrestricted research grants from: Boston Scientific; Haemonetics; Heartflow; Medtronic; speaker fees/consultancy from: Haemonetics, St Jude Medical, Abbot Vascular; Heartflow; Boston Scientific; Travel sponsorship – Biosensors, Abbot, Lilly/D-S; St Jude Medical.AbstractIntroduction: Troponin is considered to be the gold standard biomarker for ruling out MI. There has been a drive to improve the diagnostic speed, and as such the high sensitivity cardiac troponin (Hs-cTn) assays have been introduced into clinical practice and are now part of international guidelines. Their novel value in clinical practice more generally is becoming apparent. Areas covered: In this review we will evaluate the evidence for the use of Hs-cTn assays in clinical practice, the issues with the assay and the how Hs-cTn can be utilized in the future as a biomarker of cardiovascular risk.Expert Commentary: The use of the Hs-cTn assays as a ‘rule out’ test for MI is compelling, as a ‘rule in’ there are significant issues relating the specificity of the assay for MI. The future of the assay may lie in population screening and risk modeling.KeywordsTroponin, high sensitivity troponin, myocardial infarction, acute coronary syndromes, type 2 myocardial infarction, type 1 myocardial infarction1.1 What is troponin? Troponin is currently the gold standard biomarker used in clinical practice to help establish the diagnosis of myocardial infarction (MI) ADDIN EN.CITE <EndNote><Cite><Author>Babuin</Author><Year>2005</Year><RecNum>2</RecNum><IDText>Troponin: the biomarker of choice for the detection of cardiac injury</IDText><DisplayText>[1]</DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1438552933">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Babuin, L.</author><author>Jaffe, A. S.</author></authors></contributors><auth-address>Cardiovascular Division, Mayo Clinic and Mayo Clinic Graduate Medical School, Rochester, Minn 55905, USA.</auth-address><titles><title>Troponin: the biomarker of choice for the detection of cardiac injury</title><secondary-title>CMAJ</secondary-title></titles><periodical><full-title>CMAJ</full-title></periodical><pages>1191-202</pages><volume>173</volume><number>10</number><keywords><keyword>Biological Markers/analysis</keyword><keyword>Cardiovascular Diseases/*diagnosis</keyword><keyword>Cardiovascular Surgical Procedures</keyword><keyword>Humans</keyword><keyword>Prognosis</keyword><keyword>Reference Values</keyword><keyword>Renal Insufficiency/diagnosis</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Troponin/*analysis/*physiology</keyword></keywords><dates><year>2005</year><pub-dates><date>Nov 8</date></pub-dates></dates><isbn>1488-2329 (Electronic)
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ADDIN EN.CITE.DATA [3, 4]. Myofibrils are the basic contractile apparatus of myocytes. Each myofibril is composed of a thick and a thin filament. The thick filament is made up of myosin whilst actin makes up the thin filament. Troponins are classified as cardiac regulatory proteins that control the calcium-mediated interaction between actin and myosin. There are three subunits of the troponin complex: Troponin C, I and TPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYWtlZGE8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYWtlZGE8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [5]. Cardiac troponin I (cTnI) is cardiac-specific and, although cardiac troponin T can also be found in skeletal muscle, this subtype is not usually detected in currently available assaysPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SaWNjaGl1dGk8L0F1dGhvcj48WWVhcj4xOTk4PC9ZZWFy
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ADDIN EN.CITE.DATA [6]. As a consequence, the measurement of cTn is considered to be extremely specific for cardiomyocyte injury ADDIN EN.CITE <EndNote><Cite><Author>Apple</Author><Year>1999</Year><RecNum>26</RecNum><IDText>Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB</IDText><DisplayText>[7]</DisplayText><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443385170">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Apple, F. S.</author></authors></contributors><auth-address>Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis 55415, USA. fred.apple@co.hennepin.mn.us</auth-address><titles><title>Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB</title><secondary-title>Clin Chim Acta</secondary-title><alt-title>Clinica chimica acta; international journal of clinical chemistry</alt-title></titles><periodical><full-title>Clin Chim Acta</full-title><abbr-1>Clinica chimica acta; international journal of clinical chemistry</abbr-1></periodical><alt-periodical><full-title>Clin Chim Acta</full-title><abbr-1>Clinica chimica acta; international journal of clinical chemistry</abbr-1></alt-periodical><pages>151-9</pages><volume>284</volume><number>2</number><keywords><keyword>Animals</keyword><keyword>Creatine Kinase/*metabolism</keyword><keyword>Humans</keyword><keyword>Isoenzymes</keyword><keyword>Muscle, Skeletal/enzymology/*metabolism</keyword><keyword>Myocardium/enzymology/*metabolism</keyword><keyword>Troponin I/*metabolism</keyword><keyword>Troponin T/*metabolism</keyword></keywords><dates><year>1999</year><pub-dates><date>Jun 30</date></pub-dates></dates><isbn>0009-8981 (Print)
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ADDIN EN.CITE.DATA [10-12].However, plasma cTn concentrations can be raised in a variety of other conditions. (Table 1)Table 1: Causes of raised cTnCARDIAC CAUSESNON-CARDIAC CAUSESCardiac contusionPulmonary EmbolismCardiac surgeryPulmonary HypertensionCardioversionRenal FailureAcute and Chronic Heart FailureCerebrovascular diseaseAortic dissectionSepsisHypertrophic cardiomyopathyDrugsArrhythmiasExtreme exertionPost PCIBurnsHypertensionCritical illnessMyopericarditisCOPDGiven this, clinicians can be left in a dilemma when interpreting cTn serum concentrations in patients who have comorbidities such as chronic kidney disease, hypertension and heart failure. The obvious concern is therefore the potential that patients are inappropriately treated for “ACS” due to an elevated serum cTn concentration that is in fact due to an alternative aetiology. As well as a range of medications appropriate for ACS, such patients could also undergo invasive diagnostic and revascularization procedures that are not appropriate.Pre-analytical factors that can affect c-Tn concentrations include the sample type required, appropriate handling, storage and transportation of samples ADDIN EN.CITE <EndNote><Cite><Author>Tate</Author><Year>2008</Year><RecNum>716</RecNum><DisplayText>[13]</DisplayText><record><rec-number>716</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510067368">716</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tate, J. R.</author></authors></contributors><auth-address>Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. jill_tate@health..au</auth-address><titles><title>Troponin revisited 2008: assay performance</title><secondary-title>Clin Chem Lab Med</secondary-title><alt-title>Clinical chemistry and laboratory medicine</alt-title></titles><periodical><full-title>Clin Chem Lab Med</full-title><abbr-1>Clinical chemistry and laboratory medicine : CCLM / FESCC</abbr-1></periodical><pages>1489-500</pages><volume>46</volume><number>11</number><keywords><keyword>Acute Coronary Syndrome/blood/diagnosis</keyword><keyword>Antibody Specificity/immunology</keyword><keyword>Humans</keyword><keyword>Immunoassay/methods/standards/statistics & numerical data</keyword><keyword>Myocardial Infarction/blood/*diagnosis</keyword><keyword>Reference Values</keyword><keyword>Reproducibility of Results</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Specimen Handling</keyword><keyword>Troponin/*blood/immunology</keyword></keywords><dates><year>2008</year></dates><isbn>1434-6621 (Print)
1434-6621 (Linking)</isbn><accession-num>18842109</accession-num><urls><related-urls><url>;[13]. Analytical issues include sensitivity and imprecision at low concentrations, antibody specificity and immunoreactivity of plasma isoforms ADDIN EN.CITE <EndNote><Cite><Author>Tate</Author><Year>2008</Year><RecNum>716</RecNum><DisplayText>[13]</DisplayText><record><rec-number>716</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510067368">716</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tate, J. R.</author></authors></contributors><auth-address>Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. jill_tate@health..au</auth-address><titles><title>Troponin revisited 2008: assay performance</title><secondary-title>Clin Chem Lab Med</secondary-title><alt-title>Clinical chemistry and laboratory medicine</alt-title></titles><periodical><full-title>Clin Chem Lab Med</full-title><abbr-1>Clinical chemistry and laboratory medicine : CCLM / FESCC</abbr-1></periodical><pages>1489-500</pages><volume>46</volume><number>11</number><keywords><keyword>Acute Coronary Syndrome/blood/diagnosis</keyword><keyword>Antibody Specificity/immunology</keyword><keyword>Humans</keyword><keyword>Immunoassay/methods/standards/statistics & numerical data</keyword><keyword>Myocardial Infarction/blood/*diagnosis</keyword><keyword>Reference Values</keyword><keyword>Reproducibility of Results</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Specimen Handling</keyword><keyword>Troponin/*blood/immunology</keyword></keywords><dates><year>2008</year></dates><isbn>1434-6621 (Print)
1434-6621 (Linking)</isbn><accession-num>18842109</accession-num><urls><related-urls><url>;[13]. Falsely increased and decreased troponin concentrations can occur due to factors affecting the antigen-antibody reaction ADDIN EN.CITE <EndNote><Cite><Author>Lippi</Author><Year>2009</Year><RecNum>715</RecNum><DisplayText>[14]</DisplayText><record><rec-number>715</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510066841">715</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lippi, G.</author><author>Targher, G.</author><author>Franchini, M.</author><author>Plebani, M.</author></authors></contributors><auth-address>Section of Clinical Chemistry, University-Hospital of Verona, Verona, Italy. giuseppe.lippi@univr.it</auth-address><titles><title>Genetic and biochemical heterogeneity of cardiac troponins: clinical and laboratory implications</title><secondary-title>Clin Chem Lab Med</secondary-title><alt-title>Clinical chemistry and laboratory medicine</alt-title></titles><periodical><full-title>Clin Chem Lab Med</full-title><abbr-1>Clinical chemistry and laboratory medicine : CCLM / FESCC</abbr-1></periodical><pages>1183-94</pages><volume>47</volume><number>10</number><keywords><keyword>Amino Acid Sequence</keyword><keyword>Animals</keyword><keyword>Cardiomyopathies/blood/diagnosis/metabolism</keyword><keyword>Humans</keyword><keyword>*Laboratories</keyword><keyword>Mice</keyword><keyword>Molecular Sequence Data</keyword><keyword>Myocardium/*metabolism</keyword><keyword>Polymorphism, Genetic</keyword><keyword>Troponin/blood/chemistry/*genetics/*metabolism</keyword></keywords><dates><year>2009</year></dates><isbn>1437-4331 (Electronic)
1434-6621 (Linking)</isbn><accession-num>19754353</accession-num><urls><related-urls><url>;[14]. This includes autoantibodies, heterophilic antibodies, rheumatoid factors, and human anti-mouse antibodies ADDIN EN.CITE <EndNote><Cite><Author>Panteghini</Author><Year>2005</Year><RecNum>713</RecNum><DisplayText>[15]</DisplayText><record><rec-number>713</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510066655">713</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Panteghini, M.</author></authors></contributors><titles><title>Selection of antibodies and epitopes for cardiac troponin immunoassays: should we revise our evidence-based beliefs?</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>803-4</pages><volume>51</volume><number>5</number><keywords><keyword>Antibody Specificity</keyword><keyword>Autoantibodies/*blood</keyword><keyword>Epitopes</keyword><keyword>Evidence-Based Medicine</keyword><keyword>False Negative Reactions</keyword><keyword>Humans</keyword><keyword>Immunoassay</keyword><keyword>Troponin I/blood/*immunology</keyword></keywords><dates><year>2005</year><pub-dates><date>May</date></pub-dates></dates><isbn>0009-9147 (Print)
0009-9147 (Linking)</isbn><accession-num>15855663</accession-num><urls><related-urls><url>;[15] 1.2.2 Types of AssayThe early cTn assays first came into clinical practice from 1995 onwards. These assays aided clinicians in the diagnosis of acute MI with the expectation that they would provide a ‘yes/no’ answer as to whether MI had occurred. However, due to limitations in terms of the early lack of sensitivity, they could usually only be helpful and reliable some 10-12 hours post infarction. Unsurprisingly, there has been a drive to develop more sensitive troponin assays that will allow rapid exclusion of MI, in particular, in order to facilitate the early discharge of patients, preferably from the Emergency Department. This has culminated in the advent of the new highly sensitive cardiac troponin (Hs-cTn) assaysPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZWxsZXI8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [16-20]. The Hs-cTn assays are able to detect troponin at much lower concentrations than the previous assays ADDIN EN.CITE <EndNote><Cite><Author>Apple</Author><Year>2012</Year><RecNum>37</RecNum><IDText>Analytical characteristics of high-sensitivity cardiac troponin assays</IDText><DisplayText>[4]</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443397191">37</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Apple, F. S.</author><author>Collinson, P. O.</author><author>Ifcc Task Force on Clinical Applications of Cardiac Biomarkers</author></authors></contributors><auth-address>Hennepin County Medical Center, Minneapolis, MN 55415, USA. apple004@umn.edu</auth-address><titles><title>Analytical characteristics of high-sensitivity cardiac troponin assays</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>54-61</pages><volume>58</volume><number>1</number><keywords><keyword>Acute Coronary Syndrome/diagnosis</keyword><keyword>Biological Markers/blood/metabolism</keyword><keyword>Humans</keyword><keyword>Immunoassay</keyword><keyword>Myocardial Infarction/diagnosis</keyword><keyword>Myocardium/*metabolism</keyword><keyword>Reference Values</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Troponin I/*blood/metabolism</keyword><keyword>Troponin T/*blood/metabolism</keyword></keywords><dates><year>2012</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1530-8561 (Electronic)
0009-9147 (Linking)</isbn><accession-num>21965555</accession-num><urls><related-urls><url>;[4]. This is in keeping with the universal definition of MI, which recommends that a troponin assay used to diagnose MI should have a coefficient of variation (CV) of ≤ 10% at the threshold concentration representing the 99th percentile upper limit of a “normal reference” population (ULN). Modern Hs-cTn assays can detect troponin in more than 50% of the general population with some assays able to detect troponin in everyone ADDIN EN.CITE <EndNote><Cite><Author>Apple</Author><Year>2009</Year><RecNum>38</RecNum><IDText>A new season for cardiac troponin assays: it's time to keep a scorecard</IDText><DisplayText>[21]</DisplayText><record><rec-number>38</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443397907">38</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Apple, F. S.</author></authors></contributors><auth-address>Hennepin County Medical Center and University of Minnesota School of Medicine, Department of Laboratory Medicine and Pathology Minneapolis, MN 55415, USA. apple004@umn.edu</auth-address><titles><title>A new season for cardiac troponin assays: it's time to keep a scorecard</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>1303-6</pages><volume>55</volume><number>7</number><keywords><keyword>Humans</keyword><keyword>Myocardium/*chemistry</keyword><keyword>Reproducibility of Results</keyword><keyword>Troponin/*blood</keyword><keyword>United States</keyword><keyword>United States Food and Drug Administration</keyword></keywords><dates><year>2009</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1530-8561 (Electronic)
0009-9147 (Linking)</isbn><accession-num>19478023</accession-num><urls><related-urls><url>;[21]. The implications for interpretation of the results of the assay by front line staff are important: no longer is the presence of troponin a binary indicator of MI/ACS. This may is not be fully appreciated in routine clinical practice ADDIN EN.CITE <EndNote><Cite><Author>Daniels</Author><Year>2013</Year><RecNum>39</RecNum><IDText>The enemy of good?: making the most of highly sensitive troponin assays</IDText><DisplayText>[22]</DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443398331">39</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Daniels, L. B.</author></authors></contributors><titles><title>The enemy of good?: making the most of highly sensitive troponin assays</title><secondary-title>J Am Coll Cardiol</secondary-title><alt-title>Journal of the American College of Cardiology</alt-title></titles><periodical><full-title>J Am Coll Cardiol</full-title></periodical><pages>1914-6</pages><volume>61</volume><number>18</number><keywords><keyword>Female</keyword><keyword>Heart Failure/*mortality</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Troponin I/*blood</keyword></keywords><dates><year>2013</year><pub-dates><date>May 7</date></pub-dates></dates><isbn>1558-3597 (Electronic)
0735-1097 (Linking)</isbn><accession-num>23500261</accession-num><urls><related-urls><url>;[22]. The International Federation of Clinical Chemistry and Laboratory Medicine Task Force On Clinical Applications of Cardiac Bio-Markers (IFCC TF-CB) has proposed that for an assay to be defined as high-sensitivity (hs) the following criteria need to be metPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcHBsZTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [23]:The % CV at the 99th percentile value should be ≤10%.The measurable concentrations should be measured above the limit of detection (LoD) in at least 50% of healthy individuals.Examples of Hs-cTn assays available currently are shown in table 2PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcHBsZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24]. Interestingly, the hs-cTnT assay (Roche) has shown lower than recommended rates of measurable concentrations when the IFCC TF-CB criteria for hs is usedPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcHBsZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24].Table 2 : Hs-cTn assays (LoD = Limit of detection, ULN = 99th percentile, CV = Coefficient of variation)AssayLoD(ng/L)ULNM/F (ng/L)%CV at ULN10% CVng/LAbbott ARCHITECT hs-cTnI1.2/1.934/1653Roche E1 70hs-cTnT520/13813Beckman Coulter Access hs-cTnI2.552/23<1082.1 Hs-cTn as a rule out testPerhaps the major advantage of the new Hs-cTn assays is the reduction in time to rule out a diagnosis of MI. This has influenced the algorithms that are available to use to adjudicate a diagnosis of MI. In 2015 the European Society of Cardiology (ESC) produced guidelines on the management of ACSPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25], this included two algorithms, the 0/1h and the 0/3h, which both have a class I recommendation.Specifically, the 0/3h ESC algorithm recommends that MI can be ruled out if the concentrations of Hs-cTn are below the ULN in blood samples taken at presentation and 3 hours later, if they fulfill clinical conditions. Patients should be pain free and be deemed “low risk” for in hospital mortality using the Global Registry of Acute Coronary Events (GRACE) score PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25]. Where the time from onset of symptoms to presentation to hospital is over 6 hours, a single Hs-cTn concentration below the ULN is considered sufficient to rule out a diagnosis of MI. By contrast, a diagnosis of MI can be made if patients have a highly abnormal Hs-cTn with clinical correlation or if there a significant change in the 3-hour blood sample, which is assay dependentPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25]. It is important to also acknowledge that there is also a cohort of patients who will not have an elevated Hs-cTn concentration at 3 hours but may nevertheless have a later elevation and be diagnosed with MI. When using the 0/3h algorithm, one study has shown that 56% of patients are directed towards outpatient management once a diagnosis of MI is excluded, with a median time of stay in the emergency department (ED) of 4.5 hours for the patients deemed suitable for outpatient management PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ud2VyZW5ib2xkPC9BdXRob3I+PFllYXI+MjAxNjwvWWVh
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ADDIN EN.CITE.DATA [27].The 0/1h ESC algorithm does not utilize scoring systems such as GRACE in the assessment of patients presenting with suspected MIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25]. The use of the 0/1h algorithm allows clinicians to make decisions on admission to hospital or outpatient management usually within 3 hours from presentation to the emergency department. A diagnosis of MI can be safely ruled out by a very low Hs-cTn concentration, which is again assay dependent, or a low Hs-cTn concentration followed by a minimal change at 1 hour, the detail of which is again assay dependent. To illustrate this the definitive figures currently used for the Architect Hs-cTnI assay (Abbott Laboratories) are a “very low” concentration of <2 ng/L or a “low” concentration of <5ng/L, followed by a change at hour of <2ng/L. In contrast, the values for the Elecsys Hs-cTnT (Roche Diagnostics) are 5ng/L for a very low concentration, 12ng/L for the low concentration, followed by a change at 1 hour of <3ng/L. To rule in a diagnosis of MI using either the Architect or Elecsys assay an admission value of ≥ 52ng/L or a change at 1 hour of ≥6ng/L (Architect) or ≥5ng/L (Elecsys) is recommendedPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Sb2ZmaTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [25]. Use of this algorithm has been very effective with decisions made on patient destination in 75% of cases, with 15% of patients diagnosed as MI and 60% of patients in whom MI was ruled out. However, Kavsak et al ADDIN EN.CITE <EndNote><Cite><Author>Kavsak</Author><Year>2017</Year><RecNum>703</RecNum><DisplayText>[28]</DisplayText><record><rec-number>703</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510045281">703</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kavsak, P. A.</author><author>Clark, L.</author><author>Jaffe, A. S.</author></authors></contributors><auth-address>McMaster University Hamilton, ON, Canada kavsakp@mcmaster.ca.
Hamilton Health Sciences Hamilton, ON, Canada.
Mayo Clinic Rochester, MN.</auth-address><titles><title>Effect of Repeat Measurements of High-Sensitivity Cardiac Troponin on the Same Sample Using the European Society of Cardiology 0-Hour/1-Hour or 2-Hour Algorithms for Early Rule-Out and Rule-In for Myocardial Infarction</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>1163-1165</pages><volume>63</volume><number>6</number><dates><year>2017</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1530-8561 (Electronic)
0009-9147 (Linking)</isbn><accession-num>28428358</accession-num><urls><related-urls><url>;[28] have demonstrated that repeat testing on the same sample used to determine the 0h hs-cTnI concentration can lead to the reclassification of more than 10% patients when using the ESC 0/1h algorithm in contrast to 2% of patients when using the 2h algorithm. Furthermore, Pickering et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QaWNrZXJpbmc8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFy
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ADDIN EN.CITE.DATA [29] has shown that when the ESC 0/1h algorithm is utilized the sensitivity for the Hs-cTnT algorithm is 96.9%(91.5% to 100%) and for Hs-cTnI 98.8%(97.9% to 100%). This is below the 99% sensitivity, a safety level required by most physicians in the Emergency Department (ED) when investigating patients with suspected MI ADDIN EN.CITE <EndNote><Cite><Author>Than</Author><Year>2013</Year><RecNum>707</RecNum><DisplayText>[30]</DisplayText><record><rec-number>707</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1510046446">707</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Than, M.</author><author>Herbert, M.</author><author>Flaws, D.</author><author>Cullen, L.</author><author>Hess, E.</author><author>Hollander, J. E.</author><author>Diercks, D.</author><author>Ardagh, M. W.</author><author>Kline, J. A.</author><author>Munro, Z.</author><author>Jaffe, A.</author></authors></contributors><titles><title>What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the Emergency Department?: a clinical survey</title><secondary-title>Int J Cardiol</secondary-title><alt-title>International journal of cardiology</alt-title></titles><periodical><full-title>Int J Cardiol</full-title></periodical><pages>752-4</pages><volume>166</volume><number>3</number><keywords><keyword>Chest Pain/complications/*diagnosis</keyword><keyword>Data Collection/*methods</keyword><keyword>*Emergency Service, Hospital/standards</keyword><keyword>Humans</keyword><keyword>*Patient Discharge/standards</keyword><keyword>*Physicians/standards</keyword><keyword>Pilot Projects</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul 01</date></pub-dates></dates><isbn>1874-1754 (Electronic)
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ADDIN EN.CITE.DATA [2]. This concentrationis unique for each Hs-cTn assay used in clinical practice. There are 2 different forms of MI commonly defined in patients presenting acutely. Type 1 MI (T1MI) is recognized as the classical “heart attack”and is defined as a troponin elevation related to an acute plaque rupture in a suspected ACSPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaHlnZXNlbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA [2, 33, 34]. The second form of MI or type 2 MI (T2MI) is defined as MI secondary to ischaemia due to increased oxygen demand or reduced oxygen supply. Examples of clinical scenarios giving rise to T2MI include anaemia, arrhythmias, hypertension, hypotension, coronary artery spasm and embolismPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaHlnZXNlbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA [2, 34]. Other forms include MI presenting as sudden death (T3MI), myocardial damage associated with percutaneous coronary intervention (T4MI) or after coronary artery bypass grafting (T5MI). In addition, the third universal definitionPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaHlnZXNlbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA [2, 34, 35] introduces the diagnosis of myocardial injury, this is not defined as a subset of MI but is a cause of cTn concentrationsabove the ULN. In acute myocardial injury, cTn concentrations are elevated with dynamic change crucially in the absence of myocardial ischaemia. Chronic myocardial injury is used to describe scenarios where there are raised cTn concentrations but no dynamic change on serial testing. The diagnosis of myocardial injury is contentious, particularly given the considerable overlay in conditions that cause both T2MI and myocardial injury such as heart failure and sepsisPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaHlnZXNlbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA [2, 34].There are many variables that are correlated with an individual’s troponin concentration. This has a significant effect on the definition of the ULN for any particular assay. This is particularly important as each manufacturer will have different inclusion and exclusion criteria used to define the reference population from which the 99th centile is derived. For example, it has been shown that the younger the reference population is, and the stricter the criteria used to define cardiac health are, the lower the 99th centile will be.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XaWxkaTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [39] have shown that the use of gender specific cut points improves the identification of women at high risk of cardiovascular events, within a year of presentation to the ED with chest pain. In this study (n=2841), 25 out of the 1180 females recruited were reclassified from having a non-elevated troponin to having an elevated troponin, 7 (28%) of this group had a major adverse cardiovascular event (MACE) at 1 year. Shah et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [40] have also shown that gender specific cut points markedly increase the rate of MI in women from 11% to 22%. However, it has also been shown that the use of gender specific cut points in patients diagnosed with non-ST elevation acute coronary syndromes did not improve the accuracy for predicting the risk of 30 day acute MI or 1 year mortalityPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SdWJpbmkgR2ltZW5lejwvQXV0aG9yPjxZZWFyPjIwMTQ8
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ADDIN EN.CITE.DATA [42] A large number of clinical factors including eGFR, NT-proBNP, clinical criteria, history, examination and echocardiogram are all associated with an individual’s Hs-cTn concentrationPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb2VyYmluPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA [42]. In fact, after correction for these factors in this study, the 99th centile for one assay in men aged less than 75 drops from 22.9 ng/L to 10.3 ng/L. These considerations inevitably lead to a fundamentally important question: “which concentration should clinicians use as the 99th centile”? The IFCC TF-CB now recommends a 2 fold approach in which both younger (<30 years) and older (>30 years, with a mean age of 60-65 years), apparently healthy individuals are used as reference groups to define the ULN for a specific assayPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcHBsZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24]. Given what has been discussed about the sensitivity of the modern assays, and the list of clinical circumstances that can be associated with elevated troponin concentrations, this recommendation still leaves some questions unanswered. Firstly, given that Hs-cTn assays are clearly more sensitive, is it appropriate that the assay is still being used by front line clinical staff used as a ’rule in’ / ‘rule out’ tool for the diagnosis of MI, using a simple binary cut off? Secondly, and more importantly, what is an “abnormal” Hs-cTn concentration and exactly which population should be used to define that concentration? This question has important implications for the use of Hs-cTn in clinical practice. The hospital population includes individuals with a very wide spectrum of comorbidities: from outpatients with autoimmune disease to patients in intensive care. How likely is it that a single troponin concentration can be used appropriately as a binary cut off for the “ULN” in such a heterogeneous population? Furthermore, should we be using the ULN derived from a healthy young population to determine the management of the hospital population? Thus, the concept that very low or absent absent troponin concentrations can help to exclude a diagnosis of T1MI remains robust, and based upon strong data (see below). However, the assumption of a diagnosis of T1MI based upon “elevation” of the concentration beyond the ULN is, by contrast, fundamentally flawed.2.3 Underlying reasons for variability in Hs-cTn concentrationsThe variation in Hs-cTn concentrations in individuals is dependent on many factors. One important factor is age: a significant proportion of studies used to define the ULN of a Hs-cTn assay have used reference populations with a substantially younger average age than the average age of patients who suffer MIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYWVuZ2VyPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48
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ADDIN EN.CITE.DATA [43]. Eggers et al ADDIN EN.CITE <EndNote><Cite><Author>Eggers</Author><Year>2013</Year><RecNum>43</RecNum><IDText>Factors influencing the 99th percentile of cardiac troponin I evaluated in community-dwelling individuals at 70 and 75 years of age</IDText><DisplayText>[44]</DisplayText><record><rec-number>43</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443403034">43</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Eggers, K. M.</author><author>Lind, L.</author><author>Venge, P.</author><author>Lindahl, B.</author></authors></contributors><auth-address>Department of Medical Sciences, Cardiology, Uppsala University, S-751 85 Uppsala, Sweden. kai.eggers@ucr.uu.se</auth-address><titles><title>Factors influencing the 99th percentile of cardiac troponin I evaluated in community-dwelling individuals at 70 and 75 years of age</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>1068-73</pages><volume>59</volume><number>7</number><keywords><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Cardiovascular Diseases/blood</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Reference Values</keyword><keyword>Sex Factors</keyword><keyword>Troponin I/*blood</keyword></keywords><dates><year>2013</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1530-8561 (Electronic)
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ADDIN EN.CITE.DATA [37, 45]. Furthermore, patients with chronic cardiovascular disease, such as congestive HF and hypertension, were found to have twice as high ULN than those without. , A study looking at Hs-cTnT concentrations in patients admitted to the emergency department has provided further evidence about the affect of age on Hs-cTnT concentrations ADDIN EN.CITE <EndNote><Cite><Author>Hammarsten</Author><Year>2012</Year><RecNum>0</RecNum><IDText>Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction</IDText><DisplayText>[46]</DisplayText><record><dates><pub-dates><date>Mar</date></pub-dates><year>2012</year></dates><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Immunoassay</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Patients</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Troponin T</keyword></keywords><urls><related-urls><url> T percentiles from a random population sample, emergency room patients and patients with myocardial infarction</title><secondary-title>Clin Chem</secondary-title></titles><pages>628-37</pages><number>3</number><contributors><authors><author>Hammarsten, O.</author><author>Fu, M. L.</author><author>Sigurjonsdottir, R.</author><author>Petzold, M.</author><author>Said, L.</author><author>Landin-Wilhelmsen, K.</author><author>Widgren, B.</author><author>Larsson, M.</author><author>Johanson, P.</author></authors></contributors><language>eng</language><added-date format="utc">1464344695</added-date><ref-type name="Journal Article">17</ref-type><rec-number>40</rec-number><last-updated-date format="utc">1464344695</last-updated-date><accession-num>22258764</accession-num><electronic-resource-num>10.1373/clinchem.2011.171496</electronic-resource-num><volume>58</volume></record></Cite></EndNote>[46]. In patients under the age of 65, the 99th centile was 12 ng/L with little age dependence whereas in those over 65 years the 99th centile was 82 ng/L and highly age dependent.Another important association with Hs-cTn concentrations is heart failure. Hs-cTn concentrations have been shown to be raised in patients with heart failure (HF) and in patients who go on to develop HF. For example, Ergstrup et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FZ3N0cnVwPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA [47], showed that 57% of outpatients (n=417) with chronic systolic heart failure have a Hs-cTnT concentration above the ULN, when sex-specific cut off values were used (male = 18ng/L, female = 8ng/L). Furthermore, Hs-cTnI is also a predictor of mortality in HF patients ADDIN EN.CITE <EndNote><Cite><Author>McKie</Author><Year>2014</Year><RecNum>251</RecNum><IDText>High-sensitivity troponin I and amino-terminal pro--B-type natriuretic peptide predict heart failure and mortality in the general population</IDText><DisplayText>[48]</DisplayText><record><rec-number>251</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504275791">251</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McKie, P. M.</author><author>AbouEzzeddine, O. F.</author><author>Scott, C. G.</author><author>Mehta, R.</author><author>Rodeheffer, R. J.</author><author>Redfield, M. M.</author><author>Burnett, J. C.</author><author>Jaffe, A. S.</author></authors></contributors><titles><title>High-sensitivity troponin I and amino-terminal pro--B-type natriuretic peptide predict heart failure and mortality in the general population</title><secondary-title>Clin Chem</secondary-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>1225-33</pages><volume>60</volume><number>9</number><keywords><keyword>Cardiovascular Diseases</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Limit of Detection</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Natriuretic Peptide, Brain</keyword><keyword>Peptide Fragments</keyword><keyword>Predictive Value of Tests</keyword><keyword>Risk Assessment</keyword><keyword>Troponin T</keyword></keywords><dates><year>2014</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1530-8561</isbn><accession-num>24987112</accession-num><urls><related-urls><url>;[48]. This includes both cardiac- and non cardiac-related mortalityPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OYWthbXVyYTwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+
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ADDIN EN.CITE.DATA [49]. In addition, reductions Hs-cTnT concentrations have been found to closely correlate with improvements in the clinical status of HF patients ADDIN EN.CITE <EndNote><Cite><Author>Ferreira</Author><Year>2014</Year><RecNum>56</RecNum><IDText>High-sensitivity troponin T: a biomarker for diuretic response in decompensated heart failure patients</IDText><DisplayText>[50]</DisplayText><record><rec-number>56</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443659438">56</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ferreira, J. P.</author><author>Santos, M.</author><author>Almeida, S.</author><author>Marques, I.</author><author>Bettencourt, P.</author><author>Carvalho, H.</author></authors></contributors><auth-address>Internal Medicine Department, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal ; Centro Hospitalar do Porto, Porto, Portugal.
Centro Hospitalar do Porto, Porto, Portugal.
Climate Change Impacts, Adaptation and Mitigation Research Group (CC-IAM), Faculdade de Ciencias, Universidade de Lisboa, 1749-016 Lisbon, Portugal.
Centro Hospitalar de Sao Joao, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal.</auth-address><titles><title>High-sensitivity troponin T: a biomarker for diuretic response in decompensated heart failure patients</title><secondary-title>Cardiol Res Pract</secondary-title><alt-title>Cardiology research and practice</alt-title></titles><periodical><full-title>Cardiol Res Pract</full-title><abbr-1>Cardiology research and practice</abbr-1></periodical><alt-periodical><full-title>Cardiol Res Pract</full-title><abbr-1>Cardiology research and practice</abbr-1></alt-periodical><pages>269604</pages><volume>2014</volume><dates><year>2014</year></dates><isbn>2090-8016 (Print)
2090-0597 (Linking)</isbn><accession-num>25247106</accession-num><urls><related-urls><url>;[50]. Unsurprisingly, it has also been shown that patients presenting with decompensated HF with severe coronary artery disease (CAD) have a higher Hs-cTn concentration on admission when compared to patients without severe CAD. The explanation put forward for this is that patients with severe coronary stenosis are more liable to stress produced by an episode of acute decompensated HF ADDIN EN.CITE <EndNote><Cite><Author>Diez</Author><Year>2016</Year><RecNum>254</RecNum><IDText>High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure</IDText><DisplayText>[51]</DisplayText><record><rec-number>254</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504275854">254</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diez, M.</author><author>Talavera, M. L.</author><author>Conde, D. G.</author><author>Campos, R.</author><author>Acosta, A.</author><author>Trivi, M. S.</author></authors></contributors><titles><title>High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure</title><secondary-title>Cardiol J</secondary-title></titles><periodical><full-title>Cardiol J</full-title><abbr-1>Cardiology journal</abbr-1></periodical><pages>78-83</pages><volume>23</volume><number>1</number><dates><year>2016</year></dates><isbn>1897-5593</isbn><accession-num>26412605</accession-num><urls><related-urls><url>;[51].Another chronic condition that can affect troponin concentrations is blood pressure. This is evident from the observation that higher Hs-cTn concentrations have been detected in patients with hypertension compared to the normotensive population. In addition to this, rising Hs-cTn concentrations have been associated in hypertensive patients undergoing cardiac remodeling from normal LV geometry to eccentric hypertrophy. This is independent of age, gender, diabetes mellitus and renal functionPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NaWFvPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [53].The effect of chronic kidney disease (CKD) on Hs-cTn concentrations has also been well described. Thus, studies consistently demonstrates degree of Hs-cTn elevation in asymptomatic patients with chronic and end stage renal impairmentPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdW1hcjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [56]has shown that factors other than renal elimination contribute to elevated cTn in CKD. Diabetes has also been shown to be associated with elevated Hs-cTn concentrations in patients with CAD. For example, Segre et al ADDIN EN.CITE <EndNote><Cite><Author>Segre</Author><Year>2015</Year><RecNum>258</RecNum><IDText>Troponin in diabetic patients with and without chronic coronary artery disease</IDText><DisplayText>[57]</DisplayText><record><rec-number>258</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504275938">258</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Segre, C. A.</author><author>Hueb, W.</author><author>Garcia, R. M.</author><author>Rezende, P. C.</author><author>Favarato, D.</author><author>Strunz, C. M.</author><author>Sprandel, M.a C</author><author>Roggério, A.</author><author>Carvalho, A. L.</author><author>Maranh?o, R. C.</author><author>Ramires, J. A.</author><author>Kalil Filho, R.</author></authors></contributors><titles><title>Troponin in diabetic patients with and without chronic coronary artery disease</title><secondary-title>BMC Cardiovasc Disord</secondary-title></titles><periodical><full-title>BMC Cardiovasc Disord</full-title><abbr-1>BMC cardiovascular disorders</abbr-1></periodical><pages>72</pages><volume>15</volume><keywords><keyword>Aged</keyword><keyword>Biomarkers</keyword><keyword>Case-Control Studies</keyword><keyword>Cholesterol, LDL</keyword><keyword>Coronary Artery Disease</keyword><keyword>Diabetes Mellitus, Type 2</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Natriuretic Peptide, Brain</keyword><keyword>Oxidation-Reduction</keyword><keyword>Peroxidase</keyword><keyword>Risk Factors</keyword><keyword>Troponin C</keyword><keyword>Tyrosine</keyword></keywords><dates><year>2015</year></dates><isbn>1471-2261</isbn><accession-num>26195004</accession-num><urls><related-urls><url>;[57] have shown that, in the absence of ACS, Hs-cTn concentrations are higher in diabetic patients with CAD than those without. Patients who are critically ill also have elevated concentrations of troponin compared to a general population. One prospective observational study, for example, has shown 121 (84%) out of 144 critically ill patients had elevated Hs-cTn concentrations but only 40% of these patients had study-identified MIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pc3Rlcm1hbm48L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFy
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ADDIN EN.CITE.DATA [58]. Another study has shown Hs-cTn concentrations are raised within 12 hours of admission to an Intensive Care Unit in 75% of patients (n = 451). Furthermore, there was a clear association between raised Hs-cTn concentrations and both morbidity and mortality. Specifically, no patients with Hs-cTnT concentration of 3ng/L died in hospital whereas those with a concentration ≥ 50ng/L had an in hospital mortality of 31% (p<0.001). Notably, none of these patients were diagnosed as having an “ACS”PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJvbjwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [61]: in the rheumatoid arthritis group 8% of patients had a Hs-cTnT concentration above 14ng/L versus 1% of the healthy controls (p<0.007). This was independent of cardiovascular risk factors. Other conditions that are associated with elevated Hs-cTn concentrations include pulmonary emboli ADDIN EN.CITE <EndNote><Cite><Author>Walter</Author><Year>2013</Year><RecNum>61</RecNum><IDText>Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism</IDText><DisplayText>[62]</DisplayText><record><rec-number>61</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443659452">61</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Walter, T.</author><author>Apfaltrer, P.</author><author>Weilbacher, F.</author><author>Meyer, M.</author><author>Schoenberg, S. O.</author><author>Fink, C.</author><author>Gruettner, J.</author></authors></contributors><auth-address>Emergency Department; University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim D-68167, Germany.</auth-address><titles><title>Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism</title><secondary-title>Exp Ther Med</secondary-title><alt-title>Experimental and therapeutic medicine</alt-title></titles><periodical><full-title>Exp Ther Med</full-title><abbr-1>Experimental and therapeutic medicine</abbr-1></periodical><alt-periodical><full-title>Exp Ther Med</full-title><abbr-1>Experimental and therapeutic medicine</abbr-1></alt-periodical><pages>586-590</pages><volume>5</volume><number>2</number><dates><year>2013</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1792-0981 (Print)
1792-0981 (Linking)</isbn><accession-num>23403884</accession-num><urls><related-urls><url>;[62], chronic obstructive pulmonary disease ADDIN EN.CITE <EndNote><Cite><Author>H?iseth</Author><Year>2014</Year><RecNum>0</RecNum><IDText>The clinical value of serial measurement of high-sensitivity cardiac troponin T in acute exacerbations ofchronic obstructive pulmonary disease</IDText><DisplayText>[63]</DisplayText><record><urls><related-urls><url> clinical value of serial measurement of high-sensitivity cardiac troponin T in acute exacerbations ofchronic obstructive pulmonary disease</title><secondary-title>Open Heart</secondary-title></titles><pages>e000001</pages><number>1</number><contributors><authors><author>H?iseth, A. D.</author><author>Neukamm, A.</author><author>Hagve, T. A.</author><author>Omland, T.</author><author>Brekke, P. H.</author><author>S?yseth, V.</author></authors></contributors><language>eng</language><added-date format="utc">1464345569</added-date><ref-type name="Journal Article">17</ref-type><dates><year>2014</year></dates><rec-number>54</rec-number><last-updated-date format="utc">1464345569</last-updated-date><accession-num>25332772</accession-num><electronic-resource-num>10.1136/openhrt-2013-000001</electronic-resource-num><volume>1</volume></record></Cite></EndNote>[63], cerebrovascular disease ADDIN EN.CITE <EndNote><Cite><Author>Faiz</Author><Year>2014</Year><RecNum>265</RecNum><IDText>Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke</IDText><DisplayText>[64]</DisplayText><record><rec-number>265</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504276085">265</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Faiz, K. W.</author><author>Thommessen, B.</author><author>Einvik, G.</author><author>Brekke, P. H.</author><author>Omland, T.</author><author>R?nning, O. M.</author></authors></contributors><titles><title>Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke</title><secondary-title>BMC Neurol</secondary-title></titles><periodical><full-title>BMC Neurol</full-title><abbr-1>BMC neurology</abbr-1></periodical><pages>96</pages><volume>14</volume><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Brain Ischemia</keyword><keyword>Electrocardiography</keyword><keyword>Female</keyword><keyword>Hospital Mortality</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardium</keyword><keyword>Stroke</keyword><keyword>Troponin T</keyword></keywords><dates><year>2014</year></dates><isbn>1471-2377</isbn><accession-num>24885286</accession-num><urls><related-urls><url>;[64] and radiationPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ta3l0dGE8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [66] prospectively looked at Hs-cTnT concentrations of 564 patients admitted to an acute medical unit in a district general hospital in the UK. 50% of these patients had their Hs-cTnT concentration measured, and of those measured 80% (n = 224) had a raised Hs-cTnT (≥14 ng/l). Only 44 (20%) had a final diagnosis of acute MI. The authors proposed the low actual MI rate is likely to reflect the increased sensitivity but reduced specificity of the assay. These data are consistent with Saad et al ADDIN EN.CITE <EndNote><Cite><Author>Saad</Author><Year>2015</Year><RecNum>70</RecNum><IDText>Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department: a cross-sectional pilot study</IDText><DisplayText>[67]</DisplayText><record><rec-number>70</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443659481">70</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saad, Y. M.</author><author>McEwan, J.</author><author>Shugman, I. M.</author><author>Mussap, C.</author><author>Juergens, C. P.</author><author>Ferguson, I.</author><author>French, J. K.</author></authors></contributors><auth-address>Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
Department of Emergency, Liverpool Hospital, Sydney, New South Wales, Australia.</auth-address><titles><title>Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department: A cross-sectional pilot study</title><secondary-title>Emerg Med Australas</secondary-title><alt-title>Emergency medicine Australasia : EMA</alt-title></titles><periodical><full-title>Emerg Med Australas</full-title></periodical><pages>405-11</pages><volume>27</volume><number>5</number><dates><year>2015</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1742-6723 (Electronic)
1742-6723 (Linking)</isbn><accession-num>26114735</accession-num><urls><related-urls><url>;[67]. This study looked at 204 consecutive patients admitted to ED with symptoms suggestive of an ACS. 96 out of the 204 patients had Hs-cTn concentrations above the 99th centile cutoff, but only 26 of these patients had an ACS as ultimately defined by electrocardiogram changes and angiography. Stein et al ADDIN EN.CITE <EndNote><Cite><Author>Stein</Author><Year>2015</Year><RecNum>72</RecNum><IDText>Clinical implications of high-sensitivity cardiac troponin measurements in hospitalized medical patients</IDText><DisplayText>[68]</DisplayText><record><rec-number>72</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443659489">72</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stein, G. Y.</author><author>Alon, D.</author><author>Korenfeld, R.</author><author>Fuchs, S.</author></authors></contributors><auth-address>Department of Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv, Israel.</auth-address><titles><title>Clinical implications of high-sensitivity cardiac troponin measurements in hospitalized medical patients</title><secondary-title>PLoS One</secondary-title><alt-title>PloS one</alt-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><alt-periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></alt-periodical><pages>e0117162</pages><volume>10</volume><number>1</number><dates><year>2015</year></dates><isbn>1932-6203 (Electronic)
1932-6203 (Linking)</isbn><accession-num>25636061</accession-num><urls><related-urls><url>;[68] reported on Hs-cTn concentrations in 5,696 hospitalised patients. 61.6% of patients had a Hs-cTn concentration above the 99th centile, with a relative change of 50% or higher seen in 24% of patients. However, despite these relatively high numbers ACS accounted for only 6.1% of final diagnoses.It is clear that the percentage of patients with “elevated” Hs-cTn concentrations is dependent on the population that is being studied and the derivation of the reference point. It is also clear that the “normal” reference population used to define the 99th centile cutoff for manufacturer’s Hs-cTn assay is likely to be different to the population that is admitted to hospital, particularly with regard to comorbidities and “general wellness”. It is this difference between the ‘normal’ population and the population admitted to hospital that could account for reduced specificity of the Hs-cTn assays. Furthermore, there is currently no policy for manufacturers on how to choose their normal reference population to determine the 99th centile for their specific Hs-cTn assay. It has been shown that the selection strategy for the reference population significantly influenced the 99th percentile reference valuesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYWVuZ2VyPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48
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ADDIN EN.CITE.DATA [43]. To address this the IFCC TF-CB now recommends a 2 fold approach in recruiting a younger(<30 years) and older (>30 years, with a mean age of 60-65 years) reference group of healthy individuals to define the 99th percentile of a specific Hs-cTn assayPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcHBsZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [24]. As described above, there are multiple factors that can influence an individual’s Hs-cTn concentration including age, renal function, sepsis, heart failure, and diabetes mellitus. One would expect that these factors to be more prominent in the population admitted to hospital than the relatively healthy reference population used to determine the 99th centile. Currently, there are robust data to support the use of Hs-cTn concentrations of a patient as a ‘rule out’ test for ACS. For example, Shah et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [2] has classified MI into T1MI, T2MI, T3MI, T4MI, T5MI and myocardial injury. This has been driven by the development of Hs-cTn assays and the lowering of thresholds to diagnose MI. This classification has been developed according to expert consensus. For most patients presenting acutely, the intention of clinical staff is to use Hs-cTn assays to accurately and rapidly diagnose or exclude T1MI. Unfortunately, for the reasons laid out above, many patients with raised Hs-cTn are actually in the T2MI category: this has important implications for their management unless the general concentration of awareness of this potential diagnostic confusion is high. The T2MI, in which there is myocardial ischaemia due to lack of oxygen supply or increased demand, can be related due to multitude of medical and surgical conditions. There is, however, a paucity of guidelines or diagnostic criteria available for clinicians to use to adjudicate whether patients have suffered a T2MI. As such, there is significant disparity in the literature over the incidence of T2MI with the proportion of MI being attributed to T2MI ranging from 1.6% to 29.6% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJvbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [70-73]. The registry published by Baron et al ADDIN EN.CITE <EndNote><Cite><Author>Baron</Author><Year>2015</Year><RecNum>342</RecNum><DisplayText>[70]</DisplayText><record><rec-number>342</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504421020">342</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baron, T.</author><author>Hambraeus, K.</author><author>Sundstr?m, J.</author><author>Erlinge, D.</author><author>Jernberg, T.</author><author>Lindahl, B.</author><author>TOTAL-AMI study group</author></authors></contributors><titles><title>Type 2 myocardial infarction in clinical practice</title><secondary-title>Heart</secondary-title></titles><periodical><full-title>Heart</full-title></periodical><pages>101-6</pages><volume>101</volume><number>2</number><keywords><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Anemia</keyword><keyword>Comorbidity</keyword><keyword>Coronary Vessels</keyword><keyword>Female</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Male</keyword><keyword>Mortality</keyword><keyword>Myocardial Infarction</keyword><keyword>Myocardial Revascularization</keyword><keyword>Outcome Assessment (Health Care)</keyword><keyword>Patient Acuity</keyword><keyword>Platelet Aggregation Inhibitors</keyword><keyword>Registries</keyword><keyword>Renal Insufficiency</keyword><keyword>Risk Factors</keyword><keyword>Sex Factors</keyword><keyword>Sweden</keyword></keywords><dates><year>2015</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1468-201X</isbn><accession-num>25331532</accession-num><urls><related-urls><url>;[70] (n=20,138) has reported the incidence of T2MI in the MI population to be 7.1% and T1MI to be 88.5%. It should be noted, however, that there was considerable variation in the incidence of T2MI between different centres used (0-13%). There is also evidence to show that there is a greater increase in the diagnosis of T2MI in proportion to T1MI when Hs-cTn assays are used instead of cTnI assays PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [40, 74]. Inevitably, and appropriately, this raises concerns about the prospect that some patients whose true diagnosis of T2MI are being treated as T1MI: in particular, being exposed to aggressive invasive investigation and treatment for which there is no evidence base in T2MI. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA [75-77]. The study from Shah et al ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2015</Year><RecNum>320</RecNum><DisplayText>[78]</DisplayText><record><rec-number>320</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504420642">320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, A. S.</author><author>McAllister, D. A.</author><author>Mills, R.</author><author>Lee, K. K.</author><author>Churchhouse, A. M.</author><author>Fleming, K. M.</author><author>Layden, E.</author><author>Anand, A.</author><author>Fersia, O.</author><author>Joshi, N. V.</author><author>Walker, S.</author><author>Jaffe, A. S.</author><author>Fox, K. A.</author><author>Newby, D. E.</author><author>Mills, N. L.</author></authors></contributors><titles><title>Sensitive troponin assay and the classification of myocardial infarction</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></periodical><pages>493-501.e3</pages><volume>128</volume><number>5</number><keywords><keyword>Aged</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Troponin I</keyword></keywords><dates><year>2015</year><pub-dates><date>May</date></pub-dates></dates><isbn>1555-7162</isbn><accession-num>25436428</accession-num><urls><related-urls><url>;[78] has shown the utilization of lower thresholds and Hs-cTn assays reduces the risk of recurrent infarction and death in the T1MI population. By contrast, in the T2MI population, despite increasing the rates of detection and clinical investigations, there was no improvement in outcomes. This is certainly at odds with some definitions of T2MI that suggest significant coronary artery disease is required to cause T2MI as opposed to myocardial injuryPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaGFwbWFuPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48
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ADDIN EN.CITE.DATA [79, 80]. However, it cannot be overlooked that patients diagnosed with T2MI are twice as likely to be readmitted at one year with a T1MI when compared to patients who have been diagnosed with myocardial injury ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2015</Year><RecNum>320</RecNum><DisplayText>[78]</DisplayText><record><rec-number>320</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504420642">320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, A. S.</author><author>McAllister, D. A.</author><author>Mills, R.</author><author>Lee, K. K.</author><author>Churchhouse, A. M.</author><author>Fleming, K. M.</author><author>Layden, E.</author><author>Anand, A.</author><author>Fersia, O.</author><author>Joshi, N. V.</author><author>Walker, S.</author><author>Jaffe, A. S.</author><author>Fox, K. A.</author><author>Newby, D. E.</author><author>Mills, N. L.</author></authors></contributors><titles><title>Sensitive troponin assay and the classification of myocardial infarction</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></periodical><pages>493-501.e3</pages><volume>128</volume><number>5</number><keywords><keyword>Aged</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Troponin I</keyword></keywords><dates><year>2015</year><pub-dates><date>May</date></pub-dates></dates><isbn>1555-7162</isbn><accession-num>25436428</accession-num><urls><related-urls><url>;[78]. Myocardial injury is defined as an acute or chronic rise in Hs-cTn, which occurs in the absence of myocardial ischaemia. The aetiology is multifactorial. There is considerable overlap between T2MI and myocardial injury, and, in fact both conditions can occur due to the same cause such as infection. This disparity and ambiguity is highlighted by the fact that infection is cited as a cause for T2MI PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJvbjwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [70, 78, 81], where as in others it is classified as myocardial injury ADDIN EN.CITE <EndNote><Cite><Author>Saaby</Author><Year>2013</Year><RecNum>681</RecNum><DisplayText>[82]</DisplayText><record><rec-number>681</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504424023">681</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saaby, L.</author><author>Poulsen, T. S.</author><author>Hosbond, S.</author><author>Larsen, T. B.</author><author>Pyndt Diederichsen, A. C.</author><author>Hallas, J.</author><author>Thygesen, K.</author><author>Mickley, H.</author></authors></contributors><auth-address>Department of Cardiology, Odense University Hospital, Odense, Denmark.</auth-address><titles><title>Classification of myocardial infarction: frequency and features of type 2 myocardial infarction</title><secondary-title>Am J Med</secondary-title><alt-title>The American journal of medicine</alt-title></titles><periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></periodical><alt-periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></alt-periodical><pages>789-97</pages><volume>126</volume><number>9</number><keywords><keyword>Aged</keyword><keyword>Chi-Square Distribution</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Myocardial Infarction/blood/*classification</keyword><keyword>Prospective Studies</keyword><keyword>Statistics, Nonparametric</keyword><keyword>Troponin I/blood</keyword></keywords><dates><year>2013</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1555-7162 (Electronic)
0002-9343 (Linking)</isbn><accession-num>23856021</accession-num><urls><related-urls><url>;[82]. Further confusion prevails when the reported incidences of T2MI and myocardial injury are evaluated. Sarkisian et al ADDIN EN.CITE <EndNote><Cite><Author>Sarkisian</Author><Year>2016</Year><RecNum>348</RecNum><DisplayText>[83]</DisplayText><record><rec-number>348</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504421120">348</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sarkisian, L.</author><author>Saaby, L.</author><author>Poulsen, T. S.</author><author>Gerke, O.</author><author>Jangaard, N.</author><author>Hosbond, S.</author><author>Diederichsen, A. C.</author><author>Thygesen, K.</author><author>Mickley, H.</author></authors></contributors><titles><title>Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></periodical><pages>446.e5-446.e21</pages><volume>129</volume><number>4</number><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Denmark</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Prospective Studies</keyword><keyword>Troponin T</keyword></keywords><dates><year>2016</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1555-7162</isbn><accession-num>26593739</accession-num><urls><related-urls><url>;[83] have reported the incidence of myocardial injury in patients with a raised cTnI (n=1,577) to be 69% and T2MI to be 7.5%. This is in contrast to Shah et al ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2015</Year><RecNum>320</RecNum><DisplayText>[78]</DisplayText><record><rec-number>320</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504420642">320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, A. S.</author><author>McAllister, D. A.</author><author>Mills, R.</author><author>Lee, K. K.</author><author>Churchhouse, A. M.</author><author>Fleming, K. M.</author><author>Layden, E.</author><author>Anand, A.</author><author>Fersia, O.</author><author>Joshi, N. V.</author><author>Walker, S.</author><author>Jaffe, A. S.</author><author>Fox, K. A.</author><author>Newby, D. E.</author><author>Mills, N. L.</author></authors></contributors><titles><title>Sensitive troponin assay and the classification of myocardial infarction</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title><abbr-1>The American journal of medicine</abbr-1></periodical><pages>493-501.e3</pages><volume>128</volume><number>5</number><keywords><keyword>Aged</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Incidence</keyword><keyword>Length of Stay</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Troponin I</keyword></keywords><dates><year>2015</year><pub-dates><date>May</date></pub-dates></dates><isbn>1555-7162</isbn><accession-num>25436428</accession-num><urls><related-urls><url>;[78] where the incidence of myocardial injury is 24% and T2MI 20%. Irrespective of the issues relating to the classification of T2MI and myocardial injury and the considerable overlay, the outcome for both conditions is poor. Stein et al ADDIN EN.CITE <EndNote><Cite><Author>Stein</Author><Year>2014</Year><RecNum>345</RecNum><DisplayText>[81]</DisplayText><record><rec-number>345</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504421082">345</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stein, G. Y.</author><author>Herscovici, G.</author><author>Korenfeld, R.</author><author>Matetzky, S.</author><author>Gottlieb, S.</author><author>Alon, D.</author><author>Gevrielov-Yusim, N.</author><author>Iakobishvili, Z.</author><author>Fuchs, S.</author></authors></contributors><titles><title>Type-II myocardial infarction--patient characteristics, management and outcomes</title><secondary-title>PLoS One</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><pages>e84285</pages><volume>9</volume><number>1</number><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Israel</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Myocardial Infarction</keyword><keyword>Population Surveillance</keyword><keyword>Prospective Studies</keyword><keyword>Risk Factors</keyword><keyword>Survival Analysis</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2014</year></dates><isbn>1932-6203</isbn><accession-num>24392121</accession-num><urls><related-urls><url>;[81] have shown that at 30 and 1 year days there is an increased mortality in patients with T2MI compared to T1MI (30 days; 13.9% vs 4.9%, n= 2818, p<0.0001: 1 year; 23.9% vs 8.6%, p<0.0001 ). In the myocardial injury population Sarkisian et al have shown a greater risk of all cause mortality when compared to patients suffering a acute MI(59% vs 39%, p<0.0001). In this study, acute MI is defined as a cTn above the ULN alongside evidence of myocardial ischaemia, whereas myocardial injury is defined cTn above the ULN in the absence of myocardial ischaemia. Recent data from Chapman et al has shown at 5 years 60% of patients with T2MI and 75% of patients with myocardial injury were dead ADDIN EN.CITE <EndNote><Cite><Author>Chapman</Author><Year>2016</Year><RecNum>691</RecNum><DisplayText>[84]</DisplayText><record><rec-number>691</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504433382">691</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chapman, Andrew R.</author><author>Shah, Anoop S. V.</author><author>Anand, Atul</author><author>Strachan, Fiona</author><author>McAllister, David</author><author>Newby, David</author><author>Mills, Nicholas</author></authors></contributors><titles><title>113?Long Term Outcomes of Patients with Type 2 Myocardial Infarction or Myocardial Injury</title><secondary-title>Heart</secondary-title></titles><periodical><full-title>Heart</full-title></periodical><pages>A80-A80</pages><volume>102</volume><number>Suppl 6</number><dates><year>2016</year></dates><urls></urls><electronic-resource-num>10.1136/heartjnl-2016-309890.113</electronic-resource-num></record></Cite></EndNote>[84].4. Hs-cTn in the General Population: a novel biomarker for cardiovascular risk?The advent of the Hs-cTn assays now means that troponin can now be detected in over 50% of individuals, many of whom have no evidence of previous myocardial events or cardiovascular disease. This has led to observational research focused on the clinical significance of Hs-cTn concentrations in the general population. Recently, a series of such studies have shown that circulating troponin concentration in the general population are predictive of cardiovascular eventsPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYXVuZGVyczwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
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ADDIN EN.CITE.DATA [86] looked at the predictive power of Hs-cTn for cardiovascular events and mortality in large population of older community dwellers (n=5764). The study demonstrated that all cause mortality, the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD), were significantly associated with increasing concentrations of Hs-cTn. Furthermore, this increased risk was found to begin with Hs-cTn concentrations well below to ULN. Thus highlighting the potential use of Hs-cTn as a primary predictor of heart diseasePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaG9yc3RlaW5zZG90dGlyPC9BdXRob3I+PFllYXI+MjAx
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaG9yc3RlaW5zZG90dGlyPC9BdXRob3I+PFllYXI+MjAx
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ADDIN EN.CITE.DATA [86].There is evidence accumulating for the use of Hs-cTn assays in risk prediction in a variety of clinical settings. In 2015 the results from the SWEDEHEART registry (n=45,594) revealed that the introduction of Hs-cTn concentrations into clinical practice has led to the recognition of a large proportion of patients with minor troponin increases are at high risk with adjusted mortality rates beginning to increase at the concentration of the 99th percentile in healthy controlsPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NZWxraTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [88]. The majority of these patients did not have an MI. Furthermore, The West of Scotland Coronary Prevention Study (WOSCOPS) ADDIN EN.CITE <EndNote><Cite><Author>Ford</Author><Year>2016</Year><RecNum>559</RecNum><IDText>High-Sensitivity Cardiac Troponin, Statin?Therapy, and Risk of Coronary?Heart?Disease</IDText><DisplayText>[89]</DisplayText><record><rec-number>559</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504423555">559</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ford, I.</author><author>Shah, A. S.</author><author>Zhang, R.</author><author>McAllister, D. A.</author><author>Strachan, F. E.</author><author>Caslake, M.</author><author>Newby, D. E.</author><author>Packard, C. J.</author><author>Mills, N. L.</author></authors></contributors><titles><title>High-Sensitivity Cardiac Troponin, Statin?Therapy, and Risk of Coronary?Heart?Disease</title><secondary-title>J Am Coll Cardiol</secondary-title></titles><periodical><full-title>J Am Coll Cardiol</full-title></periodical><pages>2719-2728</pages><volume>68</volume><number>25</number><dates><year>2016</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1558-3597</isbn><accession-num>28007133</accession-num><urls><related-urls><url>;[89] revealed that troponin concentrations predicts coronary events and that in fact troponin concentrations can be reduced by statin therapy. This equates to a reduction in future coronary events, which is independent of cholesterol lowering. Thus illustrating the use of serial troponin monitoring in assessing cardiac risk and the efficacy of risk lowering therapies. The use of troponin as a marker of risk is not confined just to ischaemic heart disease. In a population of 8,153 elevated Hs-cTn concentrations were shown to predict the incident of diabetes in individuals without known diabetes or CVD ADDIN EN.CITE <EndNote><Cite><Author>Whelton</Author><Year>2017</Year><RecNum>561</RecNum><IDText>High-Sensitivity Cardiac Troponin T (hs-cTnT) as a Predictor of Incident Diabetes in the Atherosclerosis Risk in Communities Study</IDText><DisplayText>[90]</DisplayText><record><rec-number>561</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504423559">561</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Whelton, S. P.</author><author>McEvoy, J. W.</author><author>Lazo, M.</author><author>Coresh, J.</author><author>Ballantyne, C. M.</author><author>Selvin, E.</author></authors></contributors><titles><title>High-Sensitivity Cardiac Troponin T (hs-cTnT) as a Predictor of Incident Diabetes in the Atherosclerosis Risk in Communities Study</title><secondary-title>Diabetes Care</secondary-title></titles><periodical><full-title>Diabetes Care</full-title></periodical><pages>261-269</pages><volume>40</volume><number>2</number><edition>2016/11/15</edition><dates><year>2017</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1935-5548</isbn><accession-num>28108537</accession-num><urls><related-urls><url>;[90]. Interestingly, Hs-cTn concentrations has been postulated to have a role in personalising preventative treatment strategies in the diabetic population ADDIN EN.CITE <EndNote><Cite><Author>Cavender</Author><Year>2017</Year><RecNum>563</RecNum><IDText>Serial Measurement of High Sensitivity Troponin I and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus in the EXAMINE Trial</IDText><DisplayText>[91]</DisplayText><record><rec-number>563</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504423563">563</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cavender, M. A.</author><author>White, W. B.</author><author>Jarolim, P.</author><author>Bakris, G. L.</author><author>Cushman, W. C.</author><author>Kupfer, S.</author><author>Gao, Q.</author><author>Mehta, C. R.</author><author>Zannad, F.</author><author>Cannon, C. P.</author><author>Morrow, D. A.</author></authors></contributors><titles><title>Serial Measurement of High Sensitivity Troponin I and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus in the EXAMINE Trial</title><secondary-title>Circulation</secondary-title></titles><periodical><full-title>Circulation</full-title></periodical><edition>2017/02/28</edition><dates><year>2017</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1524-4539</isbn><accession-num>28246236</accession-num><urls><related-urls><url>;[91]. In the acute ischaemic stoke population elevated troponin concentrations in the absence of myocardial infarction has been shown to be associated with increased mortality at 1 and 3 years ADDIN EN.CITE <EndNote><Cite><Author>Wrigley</Author><Year>2017</Year><RecNum>560</RecNum><IDText>Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke</IDText><DisplayText>[92]</DisplayText><record><rec-number>560</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504423557">560</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wrigley, P.</author><author>Khoury, J.</author><author>Eckerle, B.</author><author>Alwell, K.</author><author>Moomaw, C. J.</author><author>Woo, D.</author><author>Flaherty, M. L.</author><author>De Los Rios la Rosa, F.</author><author>Mackey, J.</author><author>Adeoye, O.</author><author>Martini, S.</author><author>Ferioli, S.</author><author>Kissela, B. M.</author><author>Kleindorfer, D. O.</author></authors></contributors><titles><title>Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke</title><secondary-title>Stroke</secondary-title></titles><periodical><full-title>Stroke</full-title></periodical><edition>2017/04/05</edition><dates><year>2017</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1524-4628</isbn><accession-num>28381647</accession-num><urls><related-urls><url>;[92]. Elevated Hs-cTn concentrations in individuals with stable chronic obstructive pulmonary disease without overt CVD has been shown to be associated with increased mortality, which is independent of COPD-severity and other cardiovascular risk factors ADDIN EN.CITE <EndNote><Cite><Author>Neukamm</Author><Year>2016</Year><RecNum>562</RecNum><IDText>The prognostic value of measurement of high-sensitive cardiac troponin T for mortality in a cohort of stable chronic obstructive pulmonary disease patients</IDText><DisplayText>[93]</DisplayText><record><rec-number>562</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1504423561">562</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Neukamm, A.</author><author>Einvik, G.</author><author>Didrik H?iseth, A.</author><author>S?yseth, V.</author><author>Henrik Holmedahl, N.</author><author>Kononova, N.</author><author>Omland, T.</author></authors></contributors><titles><title>The prognostic value of measurement of high-sensitive cardiac troponin T for mortality in a cohort of stable chronic obstructive pulmonary disease patients</title><secondary-title>BMC Pulm Med</secondary-title></titles><periodical><full-title>BMC Pulm Med</full-title></periodical><pages>164</pages><volume>16</volume><number>1</number><edition>2016/11/25</edition><dates><year>2016</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1471-2466</isbn><accession-num>27887619</accession-num><urls><related-urls><url>;[93]. 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ADDIN EN.CITE.DATA [94]. Hs-cTn was detectable in 80% of individuals. There was a clear association between the Hs-cTn concentration and acute cardiovascular events. Specifically, the data shows that individuals with Hs-cTn concentrations in the top third of the population distribution are at 43% increased risk of any CVD, 59% increased risk of CHD, and 67 increased risk of fatal CVD outcomes. This risk is independent of traditional risk factors for CVD. Importantly, the meta-analysis also observed significant positive associations with CVD outcomes and Hs-cTn concentration. This is despite the fact that 85% of individuals included in the study had Hs-cTn values below the ULN (≤14ng/L). This is of particular importance showing how Hs-cTn concentrations can be utilized in primary prevention of CVD in the general population where the majority of individuals will have a concentration below the ULN.5. ConclusionRecent data raise very important questions about the potential clinical utility of Hs-cTn assays. Whilst they represent excellent tools for the early exclusion of acute MI, their use by front line staff for attempting to diagnose T1MI is flawed and the subject of considerable confusion and suboptimal education. By contrast, a growing body of evidence suggests that Hs-cTn assays may represent biomarkers for prediction of future CV risk in the general population. If validated in this role, these assays could represent powerful tools in the search for personalized prevention therapy strategies.6. Expert CommentaryThe Hs-cTn assays are now able to detect troponin at much lower concentrations than previous assays ADDIN EN.CITE <EndNote><Cite><Author>Apple</Author><Year>2012</Year><RecNum>37</RecNum><DisplayText>[4]</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="5pptap0xusx9tleap0g5dz9t2wze2f9wpvxd" timestamp="1443397191">37</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Apple, F. S.</author><author>Collinson, P. O.</author><author>Ifcc Task Force on Clinical Applications of Cardiac Biomarkers</author></authors></contributors><auth-address>Hennepin County Medical Center, Minneapolis, MN 55415, USA. apple004@umn.edu</auth-address><titles><title>Analytical characteristics of high-sensitivity cardiac troponin assays</title><secondary-title>Clin Chem</secondary-title><alt-title>Clinical chemistry</alt-title></titles><periodical><full-title>Clin Chem</full-title></periodical><pages>54-61</pages><volume>58</volume><number>1</number><keywords><keyword>Acute Coronary Syndrome/diagnosis</keyword><keyword>Biological Markers/blood/metabolism</keyword><keyword>Humans</keyword><keyword>Immunoassay</keyword><keyword>Myocardial Infarction/diagnosis</keyword><keyword>Myocardium/*metabolism</keyword><keyword>Reference Values</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Troponin I/*blood/metabolism</keyword><keyword>Troponin T/*blood/metabolism</keyword></keywords><dates><year>2012</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1530-8561 (Electronic)
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ADDIN EN.CITE.DATA [2], which recommends that a troponin assay used to diagnose MI should have a coefficient of variation of ≤ 10% at the threshold concentration representing the 99th percentile upper limit of a “normal reference” population (ULN). The evidence for the use of the Hs-cTn assays as a rule out test for MI is compellingPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYW5kb3ZhbDwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+
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AG==
ADDIN EN.CITE.DATA [78, 81, 84], in contrast to T1MI.7. Five-year viewWe expect the use of Hs-cTn assays to evolve significant over the next five years, the future for the Hs-cTn assays as we see it is in risk modeling. This would include in the primary prevention for CVD and also in a variety of conditions. We expect the Hs-cTn assays to aid clinicians in deciding whether certain therapies, such as statins, will be beneficial for patients in the long term. As a rule in test for MI, we could see the emergence of new assays that are more specific for MI.8. Key IssuesThe advent of Hs-cTn assays has allowed clinicians to make more timely management decisions on patients with suspected MI.Hs-cTn assays can now be detected in more than 50% of individuals.The improved analytical sensitivity of the assay has improved its clinical sensitivity, but has altered the specificity of the assay for MI.There is a greater proportion of patients being diagnosed with T2MI and myocardial injury with the use of the Hs-cTn assays, the outcomes in these groups is poor, with no treatment shown to alter these outcomes.The future of the Hs-cTn assays may lie in population screening and risk modeling. ADDIN EN.REFLIST 1.Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 173(10), 1191-1202 (2005).2.Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 60(16), 1581-1598 (2012).3.Saenger AK, Jaffe AS. Requiem for a heavyweight: the demise of creatine kinase-MB. Circulation 118(21), 2200-2206 (2008).4.Apple FS, Collinson PO, Biomarkers IFCC TF-CB. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem 58(1), 54-61 (2012).5.Takeda S, Yamashita A, Maeda K, Maeda Y. Structure of the core domain of human cardiac troponin in the Ca(2+)-saturated form. Nature 424(6944), 35-41 (2003).6.Ricchiuti V, Voss EM, Ney A, Odland M, Anderson PA, Apple FS. Cardiac troponin T isoforms expressed in renal diseased skeletal muscle will not cause false-positive results by the second generation cardiac troponin T assay by Boehringer Mannheim. Clin Chem 44(9), 1919-1924 (1998).7.Apple FS. Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB. Clin Chim Acta 284(2), 151-159 (1999).8.Mehta SR, Granger CB, Boden WE et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360(21), 2165-2175 (2009).9.Hoenig MR, Doust JA, Aroney CN, Scott IA. Early invasive versus conservative strategies for unstable angina & non-ST-elevation myocardial infarction in the stent era. Cochrane Database Syst Rev doi:10.1002/14651858.CD004815.pub2(3), CD004815 (2006).10.Hamm CW, Ravkilde J, Gerhardt W et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med 327(3), 146-150 (1992).11.Antman EM, Tanasijevic MJ, Thompson B et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 335(18), 1342-1349 (1996).12.Morrow DA, Cannon CP, Rifai N et al. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA 286(19), 2405-2412 (2001).13.Tate JR. Troponin revisited 2008: assay performance. Clin Chem Lab Med 46(11), 1489-1500 (2008).14.Lippi G, Targher G, Franchini M, Plebani M. Genetic and biochemical heterogeneity of cardiac troponins: clinical and laboratory implications. Clin Chem Lab Med 47(10), 1183-1194 (2009).15.Panteghini M. Selection of antibodies and epitopes for cardiac troponin immunoassays: should we revise our evidence-based beliefs? Clin Chem 51(5), 803-804 (2005).16.Keller T, Zeller T, Peetz D et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361(9), 868-877 (2009).17.Keller T, Zeller T, Ojeda F et al. Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction. JAMA 306(24), 2684-2693 (2011).18.Reichlin T, Hochholzer W, Bassetti S et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361(9), 858-867 (2009).19.Mueller M, Biener M, Vafaie M et al. Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem 58(1), 209-218 (2012).20.Christ M, Bertsch T, Popp S, Bahrmann P, Heppner HJ, Muller C. High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department. Clin Chem Lab Med 49(12), 1955-1963 (2011).21.Apple FS. A new season for cardiac troponin assays: it's time to keep a scorecard. Clin Chem 55(7), 1303-1306 (2009).22.Daniels LB. The enemy of good?: making the most of highly sensitive troponin assays. J Am Coll Cardiol 61(18), 1914-1916 (2013).23.Apple FS, Jaffe AS, Collinson P et al. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem 48(4-5), 201-203 (2015).24.Apple FS, Sandoval Y, Jaffe AS, Ordonez-Llanos J, Bio-Markers IFCC TF-CB. Cardiac Troponin Assays: Guide to Understanding Analytical Characteristics and Their Impact on Clinical Care. Clin Chem 63(1), 73-81 (2017).25.Roffi M, Patrono C, Collet JP et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37(3), 267-315 (2016).26.Twerenbold R, Jaeger C, Rubini Gimenez M et al. Impact of high-sensitivity cardiac troponin on use of coronary angiography, cardiac stress testing, and time to discharge in suspected acute myocardial infarction. Eur Heart J 37(44), 3324-3332 (2016).27.Pickering JW, Than MP, Cullen L et al. Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis. Ann Intern Med 166(10), 715-724 (2017).28.Kavsak PA, Clark L, Jaffe AS. Effect of Repeat Measurements of High-Sensitivity Cardiac Troponin on the Same Sample Using the European Society of Cardiology 0-Hour/1-Hour or 2-Hour Algorithms for Early Rule-Out and Rule-In for Myocardial Infarction. Clin Chem 63(6), 1163-1165 (2017).29.Pickering JW, Greenslade JH, Cullen L et al. Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction. Circulation 134(20), 1532-1541 (2016).30.Than M, Herbert M, Flaws D et al. What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the Emergency Department?: a clinical survey. Int J Cardiol 166(3), 752-754 (2013).31.Sandoval Y, Smith SW, Love SA, Sexter A, Schulz K, Apple FS. Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction. Am J Med 130(9), 1076-1083 e1071 (2017).32.Boeddinghaus J, Nestelberger T, Twerenbold R et al. Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I. Circulation 135(17), 1597-1611 (2017).33.Thygesen K, Alpert JS, White HD et al. Universal definition of myocardial infarction. Circulation 116(22), 2634-2653 (2007).34.Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. Eur Heart J 33(20), 2551-2567 (2012).35.Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 60(16), 1581-1598 (2012).36.Wildi K, Gimenez MR, Twerenbold R et al. Misdiagnosis of Myocardial Infarction Related to Limitations of the Current Regulatory Approach to Define Clinical Decision Values for Cardiac Troponin. Circulation 131(23), 2032-2040 (2015).37.Apple FS, Ler R, Murakami MM. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem 58(11), 1574-1581 (2012).38.Aw TC, Phua SK, Tan SP. Measurement of cardiac troponin I in serum with a new high-sensitivity assay in a large multi-ethnic Asian cohort and the impact of gender. Clin Chim Acta 422 26-28 (2013).39.Cullen L, Greenslade JH, Carlton EW et al. Sex-specific versus overall cut points for a high sensitivity troponin I assay in predicting 1-year outcomes in emergency patients presenting with chest pain. Heart 102(2), 120-126 (2016).40.Shah AS, Griffiths M, Lee KK et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ 350 g7873 (2015).41.Rubini Gimenez M, Reiter M, Twerenbold R et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med 174(2), 241-249 (2014).42.Koerbin G, Abhayaratna WP, Potter JM et al. Effect of population selection on 99th percentile values for a high sensitivity cardiac troponin I and T assays. Clin Biochem 46(16-17), 1636-1643 (2013).43.Saenger AK, Beyrau R, Braun S et al. Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin Chim Acta 412(9-10), 748-754 (2011).44.Eggers KM, Lind L, Venge P, Lindahl B. Factors influencing the 99th percentile of cardiac troponin I evaluated in community-dwelling individuals at 70 and 75 years of age. Clin Chem 59(7), 1068-1073 (2013).45.Collinson PO, Heung YM, Gaze D et al. Influence of population selection on the 99th percentile reference value for cardiac troponin assays. Clin Chem 58(1), 219-225 (2012).46.Hammarsten O, Fu ML, Sigurjonsdottir R et al. Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction. Clin Chem 58(3), 628-637 (2012).47.Egstrup M, Schou M, Tuxen CD et al. Prediction of outcome by highly sensitive troponin T in outpatients with chronic systolic left ventricular heart failure. Am J Cardiol 110(4), 552-557 (2012).48.Mckie PM, Abouezzeddine OF, Scott CG et al. High-sensitivity troponin I and amino-terminal pro--B-type natriuretic peptide predict heart failure and mortality in the general population. Clin Chem 60(9), 1225-1233 (2014).49.Nakamura Y, Yoshihisa A, Takiguchi M et al. High-sensitivity cardiac troponin T predicts non-cardiac mortality in heart failure. Circ J 78(4), 890-895 (2014).50.Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. High-sensitivity troponin T: a biomarker for diuretic response in decompensated heart failure patients. Cardiol Res Pract 2014 269604 (2014).51.Diez M, Talavera ML, Conde DG, Campos R, Acosta A, Trivi MS. High-sensitivity troponin is associated with high risk clinical profile and outcome in acute heart failure. Cardiol J 23(1), 78-83 (2016).52.Miao DM, Zhang LP, Yu HP, Zhang JY, Xiao WK, Ye P. Serum levels of high-sensitivity troponin T: a novel marker for left ventricular remodeling and performance in hypertensive subjects. Genet Mol Res 13(3), 5143-5153 (2014).53.Seliger SL, Hong SN, Christenson RH et al. High-Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure: MESA (Multi-Ethnic Study of Atherosclerosis). Circulation 135(16), 1494-1505 (2017).54.Kumar N, Michelis MF, Devita MV, Panagopoulos G, Rosenstock JL. Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrol Dial Transplant 26(2), 665-670 (2011).55.Pianta TJ, Horvath AR, Ellis VM et al. Cardiac high-sensitivity troponin T measurement: a layer of complexity in managing haemodialysis patients. Nephrology (Carlton) 17(7), 636-641 (2012).56.Van Der Linden N, Cornelis T, Kimenai DM et al. Origin of Cardiac Troponin T Elevations in Chronic Kidney Disease. Circulation 136(11), 1073-1075 (2017).57.Segre CA, Hueb W, Garcia RM et al. Troponin in diabetic patients with and without chronic coronary artery disease. BMC Cardiovasc Disord 15 72 (2015).58.Ostermann M, Lo J, Toolan M et al. A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses. Crit Care 18(2), R62 (2014).59.Baron JM, Lewandrowski EL, Januzzi JL, Bajwa EK, Thompson BT, Lewandrowski KB. Measurement of high-sensitivity troponin T in noncardiac medical intensive care unit patients. Correlation to mortality and length of stay. Am J Clin Pathol 141(4), 488-493 (2014).60.R?sj? H, Varpula M, Hagve TA et al. Circulating high sensitivity troponin T in severe sepsis and septic shock: distribution, associated factors, and relation to outcome. Intensive Care Med 37(1), 77-85 (2011).61.Avouac J, Meune C, Chenevier-Gobeaux C et al. Inflammation and disease activity are associated with high circulating cardiac markers in rheumatoid arthritis independently of traditional cardiovascular risk factors. J Rheumatol 41(2), 248-255 (2014).62.Walter T, Apfaltrer P, Weilbacher F et al. Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism. Exp Ther Med 5(2), 586-590 (2013).63.H?iseth AD, Neukamm A, Hagve TA, Omland T, Brekke PH, S?yseth V. The clinical value of serial measurement of high-sensitivity cardiac troponin T in acute exacerbations ofchronic obstructive pulmonary disease. Open Heart 1(1), e000001 (2014).64.Faiz KW, Thommessen B, Einvik G, Brekke PH, Omland T, R?nning OM. Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke. BMC Neurol 14 96 (2014).65.Skytta T, Tuohinen S, Boman E, Virtanen V, Raatikainen P, Kellokumpu-Lehtinen PL. Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy. Radiat Oncol 10 141 (2015).66.Petrie CJ, Weir RA, Anwar MS, Ali MA, Kerr M, Abed JA. High sensitivity troponin T in acute medicine; more questions than answers? QJM 107(3), 193-200 (2014).67.Saad YM, Mcewan J, Shugman IM et al. Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department: A cross-sectional pilot study. Emerg Med Australas 27(5), 405-411 (2015).68.Stein GY, Alon D, Korenfeld R, Fuchs S. Clinical implications of high-sensitivity cardiac troponin measurements in hospitalized medical patients. PLoS One 10(1), e0117162 (2015).69.Shah AS, Anand A, Sandoval Y et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 386(10012), 2481-2488 (2015).70.Baron T, Hambraeus K, Sundstr?m J et al. Type 2 myocardial infarction in clinical practice. Heart 101(2), 101-106 (2015).71.Melberg T, Burman R, Dickstein K. The impact of the 2007 ESC-ACC-AHA-WHF Universal definition on the incidence and classification of acute myocardial infarction: a retrospective cohort study. Int J Cardiol 139(3), 228-233 (2010).72.Javed U, Aftab W, Ambrose JA et al. Frequency of elevated troponin I and diagnosis of acute myocardial infarction. Am J Cardiol 104(1), 9-13 (2009).73.Gonzalez MA, Eilen DJ, Marzouq RA et al. The universal classification is an independent predictor of long-term outcomes in acute myocardial infarction. Cardiovasc Revasc Med 12(1), 35-40 (2011).74.Thygesen K, Mair J, Giannitsis E et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 33(18), 2252-2257 (2012).75.Shah AS, Newby DE, Mills NL. High sensitivity cardiac troponin in patients with chest pain. BMJ 347 f4222 (2013).76.Makam AN, Nguyen OK. Use of cardiac biomarker testing in the emergency department. JAMA Intern Med 175(1), 67-75 (2015).77.Melanson SE, Conrad MJ, Mosammaparast N, Jarolim P. Implementation of a highly sensitive cardiac troponin I assay: test volumes, positivity rates and interpretation of results. Clin Chim Acta 395(1-2), 57-61 (2008).78.Shah AS, Mcallister DA, Mills R et al. Sensitive troponin assay and the classification of myocardial infarction. Am J Med 128(5), 493-501.e493 (2015).79.Chapman AR, Adamson PD, Mills NL. Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart 103(1), 10-18 (2017).80.Alpert JS, Thygesen KA, White HD, Jaffe AS. Diagnostic and therapeutic implications of type 2 myocardial infarction: review and commentary. Am J Med 127(2), 105-108 (2014).81.Stein GY, Herscovici G, Korenfeld R et al. Type-II myocardial infarction--patient characteristics, management and outcomes. PLoS One 9(1), e84285 (2014).82.Saaby L, Poulsen TS, Hosbond S et al. Classification of myocardial infarction: frequency and features of type 2 myocardial infarction. Am J Med 126(9), 789-797 (2013).83.Sarkisian L, Saaby L, Poulsen TS et al. Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins. Am J Med 129(4), 446.e445-446.e421 (2016).84.Chapman AR, Shah ASV, Anand A et al. 113?Long Term Outcomes of Patients with Type 2 Myocardial Infarction or Myocardial Injury. Heart 102(Suppl 6), A80-A80 (2016).85.Saunders JT, Nambi V, De Lemos JA et al. Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation 123(13), 1367-1376 (2011).86.Thorsteinsdottir I, Aspelund T, Gudmundsson E et al. High-Sensitivity Cardiac Troponin I Is a Strong Predictor of Cardiovascular Events and Mortality in the AGES-Reykjavik Community-Based Cohort of Older Individuals. Clin Chem 62(4), 623-630 (2016).87.Iribarren C, Chandra M, Rana JS et al. High-sensitivity cardiac troponin I and incident coronary heart disease among asymptomatic older adults. Heart 102(15), 1177-1182 (2016).88.Melki D, Lugneg?rd J, Alfredsson J et al. Implications of Introducing High-Sensitivity Cardiac Troponin T Into?Clinical Practice: Data From the SWEDEHEART Registry. J Am Coll Cardiol 65(16), 1655-1664 (2015).89.Ford I, Shah AS, Zhang R et al. High-Sensitivity Cardiac Troponin, Statin?Therapy, and Risk of Coronary?Heart?Disease. J Am Coll Cardiol 68(25), 2719-2728 (2016).90.Whelton SP, Mcevoy JW, Lazo M, Coresh J, Ballantyne CM, Selvin E. High-Sensitivity Cardiac Troponin T (hs-cTnT) as a Predictor of Incident Diabetes in the Atherosclerosis Risk in Communities Study. Diabetes Care 40(2), 261-269 (2017).91.Cavender MA, White WB, Jarolim P et al. Serial Measurement of High Sensitivity Troponin I and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus in the EXAMINE Trial. Circulation doi:10.1161/CIRCULATIONAHA.116.024632 (2017).92.Wrigley P, Khoury J, Eckerle B et al. Prevalence of Positive Troponin and Echocardiogram Findings and Association With Mortality in Acute Ischemic Stroke. Stroke doi:10.1161/STROKEAHA.116.014561 (2017).93.Neukamm A, Einvik G, Didrik H?iseth A et al. The prognostic value of measurement of high-sensitive cardiac troponin T for mortality in a cohort of stable chronic obstructive pulmonary disease patients. BMC Pulm Med 16(1), 164 (2016).94.Willeit P, Welsh P, Evans JDW et al. High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants. J Am Coll Cardiol 70(5), 558-568 (2017). ................
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