Cardiovascular Medicine Book

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High Sensitivity Cardiac Troponin T

Aka: High Sensitivity Cardiac Troponin T, Ultrasensitive Troponin T, hs-cTnT, hsTn, Fifth Generation Troponin
  1. See Also
    1. Troponin
    2. Troponin I
    3. Troponin T
    4. Serum Cardiac Markers
  2. Background
    1. Introduced in United States in 2013, and adaptation is increasing at U.S. hospitals as of 2020
  3. Efficacy: Where negative hs-cTnT <3 ng/L
    1. Test Sensitivity: 100%
    2. Test Specificity: 34%
    3. Positive Predictive Value: 25%
    4. Negative Predictive Value: 100%
  4. Advantages
    1. Highly sensitive assays are 1,000 to 10,000 more sensitive than older assays (measured in pg/ml instead of ng/ml)
    2. Test Sensitivity is considerably better (97% sensitive) with high sensitivity assays (fewer False Negatives, NPV 99.1%)
    3. Less imprecision at discriminatory values (i.e. abnormal values are highly reproducible on repeat measurement)
    4. Abnormal rise is detected more quickly than with older assays
    5. Time to run high sensitivity assay is shorter
  5. Disadvantages
    1. Significantly worse Test Specificity than with older assays (with significantly higher False Positive Rate)
      1. See Troponin for False Positive causes
      2. hs-Troponin Is detectable in 50% of healthy patients
      3. hs-Troponin Is positive in 2% of normal patients (>99th percentile)
  6. Protocol
    1. hs-Troponin on arrival
      1. Normal if first hs-Troponin undetectable or <6 ng/L
        1. Sufficient to exclude ACS if >3 hours of symptoms, low HEART Score, EKG negative for significant findings
      2. Intermediate range if 6-52 ng/L (indication for repeat testing)
      3. Positive if >52 ng/L
    2. Indications for a second hs-Troponin at least 1 hour from first hs-Troponin
      1. Abnormal first hs-Troponin
      2. First hs-Troponin performed <3 hours from onset of symptoms
  7. References
    1. Lazarides (2013) Crit Dec Emerg Med 27(11): 2-8
    2. Swaminathan and Mattu (2020) EM:Rap 20(6): 4-5
    3. Baugh (2019) Crit Pathw Cardiol 18(1):1-4 [PubMed]
    4. Body (2011) J Am Coll Cardiol 58(13): 1332-9 [PubMed]
    5. Januzzi (2019) J Am Coll Cardiol 73(9):1059-77 [PubMed]
    6. Mueller (2016) T Ann Emerg Med 68(1): 76-87 +PMID: 26794254 [PubMed]
    7. Newby (2012) J Am Coll Cardiol 60(23): 2427-63 [PubMed]

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