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troponin T cardiac in serum/plasma

Reference interval: - 3.00 pg/mL (3 ng/L) limit of detextion - < 10 ng/L [3]; < 14 ng/L (elevated) [16] - < 5 ng/L rules out myocardial infarction (specificity 99.7%) [5,9]* - < 0.1 ng/mL (0.1 ug/L) [8] cardiac troponin-T levels should not be used for the diagnosis of acute myocardial infarction (a significant increase is used) [16] - 39% of patients with stable ischemic heart disease have levels >= 14 ng/L - these patients are considered at high risk for cardiovascular events [7]. * elevated levels become detectable > 2 hours after MI with conventional assays - newer assays are able to detects elevations sooner - significant change > 5-10 ng/L high-sensitivity troponin-T * combined with non-ischemic EGG in low-risk patients confers low 30-day risk of major adverse cardiac event [9] Procedure: - upon presentation with acute coronary syndrome & 1-4 hour(s) later - if no significant change in 1-4 hour(s), inpatient observation Clinical significance: - elevated cardiac-specific troponin-T indicates myocardial injury due to myocardial ischemia &/or myocardial infarction [8] - chest pain with an initially elevated high-sensitivity troponin-T without significant change (< 5 ng/L) after 1 hour warrants inpatient observation - does not confirm myocardial infarction - does not warrant coronary angiography - sensitivity: detectable >= 3.00 pg/mL (3.00 ng/L) - detectable levels may predict left ventricular hypertrophy, heart failure & all-cause mortality [1] - an algorithm based on changes over a 1-hour period can allegedly rule in or rule out MI in 75% of patients with acute chest pain [4] - for rule-out, sensitivity & negative predictive value > 99% - for rule-in, specificity 96% & positive predictive value 78% [6] - recheck in 2-3 hours - use of high-sensitivity assay may reduce risk of major cardiac events in patients discharged from the emergency department [11] - high-sensitivity assay results in an increase in myocardial injury & myocardial infarction diangoses, particularly in women [14] - overall resource use did not increase, except for angiography - a negative high-sensitivity assay led to more emergency department discharges & fewer cardiac tests [14] - variable specificity of mild elevations in patients with ESRD [15] - levels after non-cardiac surgery predict 30-day mortality [10] - 0.1% for <5 ng/mL - 3% for 20-64 ng/mL - 9% for 65-999 ng/mL - 30% for > 1000 ng/mL - 18% of patients meet diagnostic criteria for myocardial injury after noncardiac surgery [10] - of these, 93% do not have ischemic symptoms [10] Increases: - left ventricular hypertrophy - aortic stenosis - due to left ventricular wall stress & myocardial ischemia - heart failure - asymptomatic patients with levels in the top 1/3 with higher risk for incident heart failure than those in the bottom 1/3 (RR=2.1) [13] - ischemic heart disease [7] - myocardial injury due to myocardial ischemia &/or myocardial infarction [7] - myocarditis, pericarditis - sepsis [7] - skeletal muscle disease [2] Interferences: - high intake of biotin make result in falsely low value [12]

General

troponin T cardiac in serum/plasma/blood

References

  1. deFilippi CR et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 2010 Dec 8; 304:2494. PMID: 21078811 - de Lemos JA et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010 Dec 8; 304:2503. PMID: 21139111
  2. Jaffe AS et al. Diseased skeletal muscle: A noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol 2011 Oct 18; 58:1819. PMID: 21962825
  3. Troponin-T Laboratory Test Directory ARUP: 98803
  4. Reichlin T et al One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012 Aug 13 PMID: 22892889 http://archinte.jamanetwork.com/article.aspx?articleid=1309579 - Newby LK. Myocardial infarction rule-out in the emergency department: Are high-sensitivity troponins the answer? Arch Intern Med 2012 Aug 13 PMID: 22892634 http://archinte.jamanetwork.com/article.aspx?articleid=1309573
  5. Physician's First Watch, April 1, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  6. Reichlin T et al Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ. 2015 May 19;187(8):E243-52. PMID: 25869867 http://www.cmaj.ca/content/early/2015/04/13/cmaj.141349.full.pdf+html
  7. Everett BM et al Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes. N Engl J Med 2015; 373:610-620. August 13, 2015 PMID: 26267622 http://www.nejm.org/doi/full/10.1056/NEJMoa1415921 - Melloni C, Roe MT Cardiac Troponin and Risk Stratification in Ischemic Heart Disease. N Engl J Med 2015; 373:672-674. August 13, 2015 PMID: 26267628 http://www.nejm.org/doi/full/10.1056/NEJMe1506298
  8. Medical Knowledge Self Assessment Program (MKSAP) 17, 19. American College of Physicians, Philadelphia 2015, 2023
  9. Mokhtari A et al. Diagnostic accuracy of high-sensitivity cardiac troponin T at presentation combined with history and ECG for ruling out major adverse cardiac events. Ann Emerg Med 2016 Jul 25 PMID: 27471140 http://www.annemergmed.com/article/S0196-0644(16)30263-3/abstract
  10. Writing Committee for the VISION Study Investigators Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017;317(16):1642-1651 PMID: 28444280 http://jamanetwork.com/journals/jama/article-abstract/2620089
  11. Nejatian A et al. Outcomes in patients with chest pain discharged after evaluation using a high-sensitivity troponin T assay. J Am Coll Cardiol 2017 May 30; 69:2622 PMID: 28545635 - Levy PD. Sense and sensitivity. J Am Coll Cardiol 2017 May 30; 69:2631 PMID: 28545636
  12. FDA MedWatch Nov 28, 2017 Biotin (Vitamin B7): Safety Communication - May Interfere with Lab Tests. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm586641.htm
  13. Evans JDW, Dobbin SJH, Pettit SJ et al High-Sensitivity Cardiac Troponin and New-Onset Heart Failure. A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events. JACC: Heart Failure. January 2018 PMID: 29331272 http://heartfailure.onlinejacc.org/content/early/2018/01/02/j.jchf.2017.11.003 - Jaffe AS, Miller WL. Meta-Analyses and Interpretation of Troponin Values in Heart Failure. JACC: Heart Failure. January 2018 PMID: 29331273 http://heartfailure.onlinejacc.org/content/early/2018/01/02/j.jchf.2017.12.001
  14. Ola O, Akula A, Di Michieli L et al. Clinical impact of high-sensitivity cardiac troponin T implementation in the community. J Am Coll Cardiol 2021 Jun 29; 77:3160 PMID: 34167641 https://www.sciencedirect.com/science/article/abs/pii/S0735109721048208
  15. NEJM Knowledge+ Nephrology/Urology
  16. NEJM Knowledge+ Question of the Week September 19, 2023 https://knowledgeplus.nejm.org/question-of-week/2123/ - Twerenbold R, Costabel JP, Nestelberger T et al Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. J Am Coll Cardiol. 2019 Jul 30;74(4):483-494. PMID: 31345421 Free article. - Sandoval Y, Jaffe AS. Using high-sensitivity cardiac troponin T for acute cardiac care. Am J Med 2017 Dec; 130:1358 PMID: 28843652 - Neumann JT et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med 2019 Jun 27; 380:2529. PMID: 31242362 https://www.nejm.org/doi/full/10.1056/NEJMoa1803377
  17. Charitakis K, Nguyen TC. Severe Symptomatic Aortic Stenosis? Check Troponin, Too. J Am Heart Assoc. 2019 Mar 19;8(6):e012156. PMID: 30866695 PMCID: PMC6475068 Free PMC article.
  18. Julius BK, Spillmann M, Vassalli G, Villari B, Eberli FR, Hess OM. Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiological concepts. Circulation. 1997 Feb 18;95(4):892-8. PMID: 9054747