Martina Zaninotto
Hijazi Z et al 2012
WU AHB et al 2013
Korley F et al, 2014
2. Appropriateness of the troponin test request
Cumulative Hazards Rate for
Stroke or Systemic Embolism
according to troponin levels at
randomization (6189 patients)
hs-Troponin I
contemporary assay
99° th perc 0.04 mg/L
(10% CV
0.014 mg/L)
57%
>0.010 mg/L
24.6% >0.020 mg/L
8.1% >0.040 mg/L
Hijazi Z et al 2012
Patients in ED suffering from
acute-onset atrial fibrillation (AAF)
hs-Troponin I contemporary assay
99°th perc. 0.03 mg/L
AAF
Controls
range 0.01-0.054 mg/L
vs
range 0.01-0.03 mg/L
TnI values in AAF: 18% > 0.03 mg/L
Cardiac failure
Hypertension
Age
Diabetes
Stroke (doubled)
Hijazi Z et al 2012
AF patients (18.201) with at
least 1 CHADS, risk factor for
stroke or systemic embolism
hs-Troponin I, third generation
99°th perc. 23 ng/L
(10% CV 3.3 ng/L)
25%
50%
10%
9.2%
≤ 3.3 ng/L
>5.4 ng/L
>10.1 ng/L
>23.0 ng/L
Hijazi Z et al 2014
Cardiac death, events (%/y)
99°th perc. 23 ng/L
<3.3 ng/L
>3.3-5.4
31 (0.40)
ng/L
66 (0.92)
>5.4-10.1 ng/L
153 (2.16)
>10.1 ng/L
267 (4.24)
Hijazi Z et al 2014
Cardiac failure
Hypertension
Age >75y (doubled)
Diabetes
Stroke (doubled)
Vascular Disease
Sex (Female)
Hijazi Z et al 2014
Hijazi Z et al 2014
Hypertension
Abnormal renal and
liver functions
Previous Stroke
Prior Bleending
Labile INR
Elderly (>65y)
Drugs (antiplatelets…)
Hijazi Z et al 2014
• Although increased cTn in settings other
than ACS or heart failure is frequently
considered a clinical confounder, the
astute physician must be able to
interpret cTn as a dynamic marker of
myocardial
damage,
using
clinical
acumen to determine the source and
significance of any reported cTn increase.
Kelley WE, Januzzi, JL, Christenson RH. Clin Chem 2009
Chronic heart failure and outcome
Older adults and rate of
chronic heart failure
Miller WL et al, 2007
deFilippi CR et al, 2010
hs-TnT I=increase ≥15%; S= stable from-15 to +15%;
D= decrease ≤15% (3-4 months monitoring)
Masson S et al, 2012
Troponin I assay:
LOD
10% CV
99° perc
TnI >0.010 mg/L
at randomisation :
58.2%
at 3 months follow-up: 67.3%
Group 1
Group 2
Group 3
not detectable (<0.010 mg/L)
transient elevation
detectable (>0.010 mg/L)
Hijazi Z et al 2014
<0.006 mg/L
0.014 mg/L
0.04 mg/L
Hijazi Z et al 2014
Hijazi Z et al 2014
Hijazi Z et al 2014
AMI
Decision
limit
?
Masson S et al. 2012
AMI Decision
limit
?
Baseline hs-TnI level
98.5% ≥ 1.2 pg/mL (LOD)
2.9% ≥ w 15.6; m 34.2 pg/mL
(99°th healthy subjects)
R
Risk for cardiovascular
death or heart failure by baseline hs-TnI level in stable CAD
Omland T et al 2013
Casagranda I et al, 2013