RT Journal Article
SR Electronic
T1 Clinical Considerations of High Sensitivity Troponins and CVD
JF American Society for Clinical Laboratory Science
JO Clin Lab Sci
FD American Society of Chemistry and Laboratory Science
SP 205
OP 213
DO 10.29074/ascls.2018000695
VO 31
IS 4
A1 Xavier, Neena
A1 Hallman, Heather
A1 George, Remo
A1 Gilford, Tosi
A1 Estes, Robert
A1 Giordano, Samantha
A1 Glasgow, Krystle
A1 Li, Wei
A1 Oliveira, Ana
A1 Josephat, Floyd
A1 Marie Chiasera, Janelle
YR 2018
UL http://hwmaint.clsjournal.ascls.org/content/31/4/205.abstract
AB Cardiovascular disease (CVD) remains the number one cause of death in the United States (US). According to the American Heart Association, it causes roughly 2300 deaths per day, and one death about every 38 seconds. The introduction and generalized use of high-sensitivity cardiac troponins (hs-cTn) has the potential to improve diagnosis, which would allow for shorter times to reperfusion and better patient outcomes. Emergency departments in the US have established evidence-based protocols that aid providers in ruling out acute coronary syndrome or acute myocardial infarction. These protocols currently use traditional troponin assays, but are validated using high-sensitivity troponin assays. With the advent of high-sensitivity troponin assays, however, clinicians must have care in their interpretation. The myonecrosis that leads to elevations in serum troponins is not a disease-specific phenomenon, but rather is organ-specific. As such, several diseases exist other than acute myocardial infarction (AMI) that can lead to troponin elevations. It is important for providers to use these biomarkers as an adjunct to the clinical picture to determine diagnosis, management, and treatment. High-sensitivity troponin assays are also being studied to evaluate risk stratification and prognosis for CVD disorders such as procedural outcomes, transplant recipients, and chronic stable angina. The data shows mixed results in terms of applicability for risk stratification and prognosis but will likely evolve over time. Finally, the 2015 European Society of Cardiology (ESC) guidelines include an algorithm for managing acute coronary syndrome (ACS) using a 0/1-hour hs-cTn testing based on studies that demonstrated a 97% sensitivity for a 1 h testing protocol. The guidelines included 2 methods of ruling out AMI, (1) a single sample with hs-cTn levels that were undetectable and (2) a change of 6ng/L between 0 and 1 h or absolute threshold concentration > 52ng/L. In 2017, the US Food and Drug Administration cleared high-sensitivity assays for use in the United States. Continued studies are needed in the United States to determine if protocols using hs-cTn lead to early diagnosis and, subsequently, improved patient outcomes. Studies are needed to incorporate the use of hs-cTn as a better prognostic indicator for various cardiac diseases and interventions.