Importance: Physicians need information on how to use the first available high-sensitivity troponin (hsTnT) assay in the United States to identify patients at very low risk for 30-day adverse cardiac events (ACE). Objective: To determine whether a negative hsTnT assay at 0 and 3 hours following emergency department presentation could identify
2011-07-01
However, its determinants remain partially unknown. We aimed to assess the relationship The median hsTnT value for the group as a whole was 5.4 pg/mL (interquartile range [IQR] 2.7 to 9.0] pg/mL). Overall, 62 (16.4%) had an hsTnT ≥13 pg/mL. Median concentrations of hsTnT were significantly higher among those patients judged to have an ACS than among those without (28.0 [IQR 8.6 to 68.7] versus 7.0 [IQR 2.5 to 8.1] pg/mL, P<0 The high-sensitivity troponin T (hsTnT) assay allows for more rapid assessment of acute coronary syndrome.
More myocardial injury will be detected with hsTnT : The assay is able reliably to detect lower levels than prior assays and in doing so, there may be a measurable amount of cardiac injury even in patients who present due to nonAMI situations. Results w- ill be reported out with the following comment: The newest high sensitive 5th generation cardiac TnT assay (hsTnT) detects an elevation in TnT levels within 1 hour of the onset of myocardial infarction.1 It also measures low levels of TnT that were undetectable in prior assay generations, in subjects that do not have myocardial infarction. The new hsTnT assay is reported to be able to hsTnT Reference Interval (males and females, age >1 year) <14 ng/L *Any result above the reference range will be flagged. For a baseline hsTnT (i.e. no troponin testing in the past 12 hours): For a follow-up hsTnT (i.e. troponin testing was performed in the past 12 hours), the following generic comment will be added: The upper reference level for the hsTnT assay, defined as the 99th percentile, was established as 19 ng/L in a separate healthy US cohort. Patients were considered ruled out for acute myocardial infarction if their hsTnT level at 0 hours and 3 hours was less than the upper reference level.
Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Fewer MACE in Discharged Chest-Pain Patients Evaluated with hsTnT.
While the hsTnT assays have improved diagnostic yield in AMI, a number of non-cardiac conditions are associated with elevations in hsTnT (e.g. heart failure, tachyarrhythmias, pulmonary In this analysis, we used a hsTnT URL cutoff level of 19 ng/L.
In a recent study where high-sensitivity troponin T (hsTnT) was the index test,9 the authors describe the gold standard determination of myocardial infarction as: ’An independent clinical events committee (CEC), made up of 2 cardiologists and one emergency physician, adjudicated the acute myocardial infarction (AMI) diagnosis for each patient per the Third Universal Definition of AMI criteria.
ACB News 571, p20-21, November 2010 Yes Greater than 50 ng/L High Risk of ACS INTRODUCTION AND AIMS: The clinical interpretation of a raised level of high-sensitivity troponin T (hsTnT) or N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is uncertain in patients with chronic kidney disease (CKD) due to the relationship of these biomarkers to reduced kidney function.
Adults 25 years and older with chest pain. No ischemic changes on initial ECG, initial hsTnT level < 5 ng per L. 8,907/14,636
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> 6 hrs of symptoms? 2 ndhsTnT (taken at >6 hours post symptom onset AND >3 hours from 1st test) 1st or 2 Result > 14 and > 50% change ? YES YES NO NO YES NO switching to hs Troponin T (hsTnT) 5th Generation assay by Roche. Troponins are released during myocyte necrosis and/or increased permeability of the cell wall. Generally they are cardiac specific, however are not specific for acute myocardial infarction (AMI).
2018-11-02
High Sensitivity Troponin (hsTnT) : Result Interpretation Matrix* 1st hsTnT on presentation High Risk of Myocardial Ischaemia Low Risk of Myocardial Ischaemia Clinical Assessment Result > 14 ? Result > 100 ? > 6 hrs of symptoms?
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Methods and results: The biological variability of established biomarkers [NT-proBNP and high-sensitivity troponin T (hsTnT)], novel biomarkers [galectin-3, suppression of tumorigenicity 2 (ST2), and growth differentiation factor 15 (GDF-15)], and renal/neurohormonal biomarkers (aldosterone, phosphate, parathyroid hormone, plasma renin concentration, and creatinine) was determined in 28 healthy subjects and 83 HF patients, over a period of 4 months and 6 weeks, respectively.
Patients with increased hsTnT and plaque burden (n = 53) showed the highest incidence for hard cardiac events (annual rate, 12.7%), followed by those with either increased hsTnT or plaque burden (n = 145; annual rate = 0.44%, P < .03), while those with lower hsTnT and plaque burden exhibited excellent outcomes and no hard event during the follow-up duration (n = 210; annual rate = 0%, P < .001). An absolute hsTnT change of at least 5 ng/L across any hsTnT measurements was also associated with an increased risk of 30-day mortality. Only 11.0% of elevated postoperative hsTnT measurements (ie, an hsTnT level of 20 to <65 ng/L with an absolute change ≥5 ng/L or an hsTnT level ≥65 ng/L) were adjudicated as having a nonischemic etiology.
While the hsTnT assays have improved diagnostic yield in AMI, a number of non-cardiac conditions are associated with elevations in hsTnT (e.g. heart failure, tachyarrhythmias, pulmonary
Only 11.0% of elevated postoperative hsTnT measurements (ie, an hsTnT level of 20 to <65 ng/L with an absolute change ≥5 ng/L or an hsTnT level ≥65 ng/L) were adjudicated as having a nonischemic etiology. Patients with increased hsTnT and plaque burden (n = 53) showed the highest incidence for hard cardiac events (annual rate, 12.7%), followed by those with either increased hsTnT or plaque burden (n = 145; annual rate = 0.44%, P < .03), while those with lower hsTnT and plaque burden exhibited excellent outcomes and no hard event during the follow-up duration (n = 210; annual rate = 0%, P < .001).
While the hsTnT assays have improved diagnostic yield in AMI, a number of non-cardiac conditions are associated with elevations in hsTnT (e.g.