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