Skip to main content
SpringerLink
Log in

Pre-analytical Factors and Analytical Issues Affecting Interpretation of Cardiovascular Biomarkers

  • Chapter
  • First Online:
Cardiac Biomarkers

  • 1283 Accesses

Abstract

The Universal Definition of Myocardial Infarction globally endorses cardiac troponin (T and I; cTnT, cTnI) as the biomarker of choice for the diagnosis and assessment of acute coronary syndrome (ACS) and should be utilized routinely in patients with symptoms suggestive of acute myocardial infarction (AMI) [1]. Despite the widespread use of troponin in clinical practice there remain a number of pre-analytical, analytical and interpretive issues which can confound clinical interpretation and will likely be magnified with high-sensitivity troponin assays. The following case studies and discussion highlight some of these issues and nuances associated with troponin assays.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126:2020–35.

    Article  PubMed  Google Scholar 

  2. Florkowski C, Wallace J, Walmsley T, George P. The effect of hemolysis on current troponin assays–a confounding preanalytical variable? Clin Chem. 2010;56:1195–7.

    Article  CAS  PubMed  Google Scholar 

  3. Lyon ME, Ball CL, Krause RD, Slotsve GA, Lyon AW. Effect of hemolysis on cardiac troponin T determination by the Elecsys 2010 immunoanalyzer. Clin Biochem. 2004;37:698–701.

    Article  CAS  PubMed  Google Scholar 

  4. Bais R. The effect of sample hemolysis on cardiac troponin I and T assays. Clin Chem. 2010;56:1357–9.

    Article  CAS  PubMed  Google Scholar 

  5. Ong ME, Chan YH, Lim CS. Observational study to determine factors associated with blood sample haemolysis in the emergency department. Ann Acad Med Singapore. 2008;37:745–8.

    PubMed  Google Scholar 

  6. Sodi R, Darn SM, Davison AS, Stott A, Shenkin A. Mechanism of interference by haemolysis in the cardiac troponin T immunoassay. Ann Clin Biochem. 2006;43:49–56.

    Article  CAS  PubMed  Google Scholar 

  7. Katrukha AG, Bereznikova AV, Filatov VL, et al. Degradation of cardiac troponin I: implication for reliable immunodetection. Clin Chem. 1998;44:2433–40.

    CAS  PubMed  Google Scholar 

  8. Koch CD, Wockenfus AF, Saenger AK, Jaffe AS, Karon BS. BD rapid serum tubes reduce false positive plasma troponin T results on the Roche Cobas e411 analyzer. Clin Biochem. 2012;45:842–4.

    Article  CAS  PubMed  Google Scholar 

  9. Sonntag O. Haemolysis as an interference factor in clinical chemistry. J Clin Chem Clin Biochem. 1986;24:127–39.

    CAS  PubMed  Google Scholar 

  10. Apple FS, Collinson PO, Biomarkers ITFoCAoC. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem. 2012;58:54–61.

    Article  CAS  PubMed  Google Scholar 

  11. Amundson BE, Apple FS. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction. Clin Chem Lab Med. 2015;53:665–76.

    Article  CAS  PubMed  Google Scholar 

  12. Apple FS, Ler R, Murakami MM. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012;58:1574–81.

    Article  CAS  PubMed  Google Scholar 

  13. Aldous S, Mark Richards A, George PM, et al. Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction. Int J Cardiol. 2014;177:182–6.

    Article  PubMed  Google Scholar 

  14. Palamalai V, Murakami MM, Apple FS. Diagnostic performance of four point of care cardiac troponin I assays to rule in and rule out acute myocardial infarction. Clin Biochem. 2013;46:1631–5.

    Article  CAS  PubMed  Google Scholar 

  15. Dupuy AM, Sebbane M, Roubille F, et al. Analytical evaluation of point of care cTnT and clinical performances in an unselected population as compared with central laboratory highly sensitive cTnT. Clin Biochem. 2015;48:334–9.

    Article  PubMed  Google Scholar 

  16. Singh J, Akbar MS, Adabag S. Discordance of cardiac troponin I assays on the point-of-care i-STAT and Architect assays from Abbott diagnostics. Clin Chim Acta. 2009;403:259–60.

    Article  CAS  PubMed  Google Scholar 

  17. Venge P, Ohberg C, Flodin M, Lindahl B. Early and late outcome prediction of death in the emergency room setting by point-of-care and laboratory assays of cardiac troponin I. Am Heart J. 2010;160:835–41.

    Article  CAS  PubMed  Google Scholar 

  18. Loten C, Attia J, Hullick C, Marley J, McElduff P. Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: a randomised controlled trial. Emerg Med J. 2010;27:194–8.

    Article  PubMed  Google Scholar 

  19. Di Serio F, Antonelli G, Trerotoli P, Tampoia M, Matarrese A, Pansini N. Appropriateness of point-of-care testing (POCT) in an emergency department. Clin Chim Acta. 2003;333:185–9.

    Article  PubMed  Google Scholar 

  20. Apple FS, Ler R, Chung AY, Berger MJ, Murakami MM. Point-of-care i-STAT cardiac troponin I for assessment of patients with symptoms suggestive of acute coronary syndrome. Clin Chem. 2006;52:322–5.

    Article  CAS  PubMed  Google Scholar 

  21. Blick KE. The benefits of a rapid, point-of-care “TnI-Only” zero and 2-hour protocol for the evaluation of chest pain patients in the Emergency Department. Clin Lab Med. 2014;34:75–85, vi.

    Article  PubMed  Google Scholar 

  22. Collinson PO, John C, Lynch S, et al. A prospective randomized controlled trial of point-of-care testing on the coronary care unit. Ann Clin Biochem. 2004;41:397–404.

    Article  CAS  PubMed  Google Scholar 

  23. Saenger AK, Beyrau R, Braun S, et al. Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin Chim Acta. 2011;412:748–54.

    Article  CAS  PubMed  Google Scholar 

  24. Tate JR, Bunk DM, Christenson RH, et al. Evaluation of standardization capability of current cardiac troponin I assays by a correlation study: results of an IFCC pilot project. Clin Chem Lab Med. 2015;53:677–90.

    Article  CAS  PubMed  Google Scholar 

  25. Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254–61.

    Article  CAS  PubMed  Google Scholar 

  26. Apple FS, Jaffe AS, Collinson P, et al. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem. 2015;48:201–3.

    Article  CAS  PubMed  Google Scholar 

  27. García-Mancebo ML, Agulló-Ortuño MT, Gimeno JR. Heterophile antibodies produce spuriously elevated concentrations of cardiac Troponin I in patients with Legionella pneumophila. Clin Biochem. 2005;38(6):584–7.

    Article  PubMed  Google Scholar 

  28. Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol. 2011;58:1819–24.

    Article  PubMed  Google Scholar 

  29. Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS. Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem. 2009;55:573–7.

    Article  CAS  PubMed  Google Scholar 

  30. Kavsak PA, Caruso N, Beattie J, Clark L. Centrifugation - an important pre-analytical factor for the Abbott Architect high-sensitivity cardiac troponin I assay. Clin Chim Acta. 2014;436:273–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA

    Amy K. Saenger PhD, DABCC

Authors
  1. Amy K. Saenger PhD, DABCC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy K. Saenger PhD, DABCC .

Editor information

Editors and Affiliations

  1. Division of Cardiovascular Medicine, University of California San Diego Division of Cardiovascular Medicine, La Jolla, California, USA

    Alan S. Maisel

  2. Cardiology Department, Mayo Clinic Cardiology Department, ROCHESTER, Minnesota, USA

    Allan S. Jaffe

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Saenger, A.K. (2016). Pre-analytical Factors and Analytical Issues Affecting Interpretation of Cardiovascular Biomarkers. In: Maisel, A., Jaffe, A. (eds) Cardiac Biomarkers. Springer, Cham. https://doi.org/10.1007/978-3-319-42982-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42982-3_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42980-9

  • Online ISBN: 978-3-319-42982-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation