Variability of cardiac troponin levels in normal subjects and in patients with cardiovascular diseases: analytical considerations and clinical relevance A consensus document by the Study Group on Cardiac Biomarkers from Italian Society of Biochemical Chemistry (SIBioC) and European Ligand Assay Society (ELAS)

被引:29
作者
Clerico, Aldo [1 ]
Zaninotto, Martina [2 ,3 ,4 ]
Aimo, Alberto [1 ]
Cardinale, Daniela M. [5 ]
Dittadi, Ruggero [6 ,7 ]
Sandri, Maria T. [8 ]
Perrone, Marco Alfonso [9 ,10 ]
Belloni, Lucia
Fortunato, Antonio [11 ]
Trenti, Tommaso [12 ]
Plebani, Mario [2 ,3 ,4 ]
机构
[1] Scuola Super St Anna & Fdn CNR, Reg Toscana G Monasterio, Pisa, Italy
[2] Univ Osped Padova, Dipartimento Med Lab, Padua, Italy
[3] Univ Padua, Azienda Ospedaliera Univ Padova, Padua, Italy
[4] Univ Padua, Fac Med & Chirurg, Padua, Italy
[5] Ist Europeo Oncol, Unita Cardioncol, IRCCS, Milan, Italy
[6] Osped Angelo, Unita Med Lab, Azienda ULSS 3, Venice, Italy
[7] Ctr Regionale Biomarcatori, Dipartimento Patol Clin, Azienda ULSS 3, Venice, Italy
[8] Lab Bianal, Carate Brianza, Monza & Brianza, Italy
[9] Univ & Osped Tor Vergata, Dipartimento Biochim Clin, Rome, Italy
[10] Univ & Osped Tor Vergata, Div Cardiol, Rome, Italy
[11] Patol Clin, Area Vasta 5 ASUR Marche, Ascoli Piceno, Italy
[12] Azienda USL Modena, Dipartimento Patol Clin & Lab, Modena, Italy
关键词
acute myocardial infarction; biological variation; cardiac troponins; cardio-toxicity; cardiovascular risk; immunoassay methods; myocardial injury; natriuretic peptides; HIGH-SENSITIVITY TROPONIN; ST-SEGMENT ELEVATION; TERM BIOLOGICAL VARIATION; ACUTE CORONARY SYNDROMES; NATRIURETIC PEPTIDE BNP; CHRONIC HEART-FAILURE; OF-THE-ART; 99TH PERCENTILE; MYOCARDIAL-INFARCTION; NONCARDIAC SURGERY;
D O I
10.1515/cclm-2022-1285
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI and hs-cTnT variations is particularly relevant: a) for the differential diagnosis of Acute Coronary Syndromes (ACS) in patients admitted to the Emergency Department (ED); b) for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged > 55 years and with co-morbidities; c) for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.
引用
收藏
页码:1209 / 1229
页数:21
相关论文
共 157 条
[1]   Analytical Considerations in Deriving 99th Percentile Upper Reference Limits for High-Sensitivity Cardiac Troponin Assays: Educational Recommendations from the IFCC Committee on Clinical Application of Cardiac Bio-Markers [J].
Aakre, Kristin M. ;
Saenger, Amy K. ;
Body, Rick ;
Collinson, Paul ;
Hammarsten, Ola ;
Jaffe, Allan S. ;
Kavsak, Pete ;
Omland, Torbjorn ;
Ordonez-Lianos, Jordi ;
Apple, Fred S. .
CLINICAL CHEMISTRY, 2022, 68 (08) :1022-1030
[2]   Weekly and 90-Minute Biological Variations in Cardiac Troponin T and Cardiac Troponin I in Hemodialysis Patients and Healthy Controls [J].
Aakre, Kristin M. ;
Roraas, Thomas ;
Petersen, Per Hyltoft ;
Svarstad, Einar ;
Sellevoll, Hilde ;
Skadberg, Oyvind ;
Saele, Kristin ;
Sandberg, Sverre .
CLINICAL CHEMISTRY, 2014, 60 (06) :838-847
[3]   High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis [J].
Aimo, Alberto ;
Georgiopoulos, Georgios ;
Panichella, Giorgia ;
Vergaro, Giuseppe ;
Passino, Claudio ;
Emdin, Michele ;
Clerico, Aldo .
EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2022, 98 :61-68
[4]   Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio-Oncology Guidelines [J].
Alexandre, Joachim ;
Cautela, Jennifer ;
Ederhy, Stephane ;
Damaj, Ghandi Laurent ;
Salem, Joe-Elie ;
Barlesi, Fabrice ;
Farnault, Laure ;
Charbonnier, Aude ;
Mirabel, Mariana ;
Champiat, Stephane ;
Cohen-Solal, Alain ;
Cohen, Ariel ;
Dolladille, Charles ;
Thuny, Franck .
JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2020, 9 (18)
[5]   Myocardial infarction redefined -: A consensus Document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction [J].
Alpert, JS ;
Antman, E ;
Apple, F ;
Armstrong, PW ;
Bassand, JP ;
de Luna, AB ;
Beller, G ;
Breithardt, G ;
Chaitman, BR ;
Clemmensen, P ;
Falk, E ;
Fishbein, MC ;
Galvani, M ;
Garson, A ;
Grines, C ;
Hamm, C ;
Jaffe, A ;
Katus, H ;
Kjekshus, J ;
Klein, W ;
Klootwijk, P ;
Lenfant, C ;
Levy, D ;
Levy, RI ;
Luepker, R ;
Marcus, F ;
Näslund, U ;
Ohman, M ;
Pahlm, O ;
Poole-Wilson, P ;
Popp, R ;
Alto, P ;
Pyörälä, K ;
Ravkilde, J ;
Rehnquist, N ;
Roberts, W ;
Roberts, R ;
Roelandt, J ;
Rydén, L ;
Sans, S ;
Simoons, ML ;
Thygesen, K ;
Tunstall-Pedoe, H ;
Underwood, R ;
Uretsky, BF ;
Van de Werf, F ;
Voipio-Pulkki, LM ;
Wagner, G ;
Wallentin, L ;
Wijns, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (03) :959-969
[6]  
[Anonymous], 2021, Eur Heart J, V42, P1908, DOI 10.1093/eurheartj/ehaa895
[7]  
[Anonymous], 2001, Biological Variation: From Principles to Practice
[8]  
[Anonymous], 1977, Exploratory Data Analysis
[9]   Determination of sex-specific 99th percentile upper reference limits for a point of care high sensitivity cardiac troponin I assay [J].
Apple, Fred S. ;
Schulz, Karen ;
Schmidt, Christian W. ;
van Domburg, Trees S. Y. ;
Fonville, Judith M. ;
de Theije, Femke K. .
CLINICAL CHEMISTRY AND LABORATORY MEDICINE, 2021, 59 (09) :1574-1578
[10]   Getting Cardiac Troponin Right: Appraisal of the 2020 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation by the International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Applications of Cardiac Bio-Markers [J].
Apple, Fred S. ;
Collinson, Paul O. ;
Kavsak, Peter A. ;
Body, Richard ;
Ordonez-Llanos, Jordi ;
Saenger, Amy K. ;
Omland, Torbjorn ;
Hammarsten, Ola ;
Jaffe, Allan S. .
CLINICAL CHEMISTRY, 2021, 67 (05) :730-735