Sei sulla pagina 1di 60

Troponina T ad

alta sensibilit
16 dicembre 2010/10 gennaio 2011
31 gennaio 2011 Cesena
1 febbraio 2011 Rimini
7 febbraio 2011 Forl
1

necessario che il laboratorio ed i reparti


clinici trovino un accordo su quali cut-off sia
meglio adottare
I dosaggi ad alta sensibilit delle troponine
cardiache I e T mostrano una migliore
sensibilit analitica e clinica rispetto ai
vecchi metodi meno sensibili.
Questo incremento di sensibilit permetter
di evidenziare pi precocemente una
necrosi cardiaca rispetto al passato.
2

Circa la met dei pazienti con


sospetta sindrome coronarica acuta e
Tn hs aumentate potrebbero avere
patologie cardiache acute non
causate da SCA.
Misure seriate (entro le 3-6 ore) delle
Tn utili a distinguere tra SCA e altre
patologie acute non-ischemiche.
3

I
professionisti
suggeriscono
cautela
4

Le Aziende di
diagnostici
sono partite
Le aziende
sanitarie sono
partite
7

10

11

12

0.03 g/L Tropo T =


50 ng/l Tropo T hs
13

14

AVR
15

16

17

18

rule out
19

rule in
20

Memento
21

Rimangono le
troponinosi
22

23

Mean age 4413.8 years

24

25

26

in June in Manchester Clinical Biochemists and Roche

The Roche Elecsys high sensitive


troponin T (hsTnT) assay meets these
performance criteria (10% CV is at 13
ng/L, the 99percentile is 14 ng/L) and is
now being introduced in laboratories
throughout the world.
27

in June in Manchester Clinical Biochemists and Roche

the reporting units should be ng/L


results reported down to 3 ng/L
two measurements required
2 sample: 6-9 hours after
presentation
if the 2sample not an incremental
rise, yet clinical suspicion, a further
sample at 12 hours.
28

in summer in Cardiff Clinical Biochemists and Roche

a: Less than 20% change: not


consistent with an acute event
b: 20-100% change: suggest
further evaluation
c: Greater than 100% change:
consistent with myocardial
infarction.
29

in June in Manchester Clinical Biochemists and Roche

Patients with hsTnT chronically >14 ng/L


are at risk of future cardiac events
No conclusion was reached on what
single level of hsTnT could be used to
diagnose an MI
It is recognised that as evidence
accumulates, practices may change
accordingly.
A consensus approach is preferable
to multiple local practices.
30

31

32

Results reported in ng/L


Results from the hs-TnT assay will be
reported in ng/L rather than the
previously used ug/L. This produces
number which are 1000 times higher
and all results will be in whole
numbers. For example a result of 0.015
ug/L becomes 15 ng/L. This will
reduce reading and transcription
errors.
33

New Reference Interval:0-14 ng/L


Results of 15 ng/L and above are
considered elevated.
It is estimated that here will be
more 2-3 times patients with
elevated troponin
Many of these will have conditions
other than ACS
34

AMI
Patients with a good history for
AMI and Troponin T >100 ng/L can
be diagnosed with a single Tn result
A delta troponin >30% within
3 12 hours together with at least
one Tn hs supportive of AMI.
A stable troponin elevation (delta
less than 30%) is more likely in
other diagnoses.
35

36

37

38

1.Units: It was agreed that the reporting


units for hs-cTnT should be ng/L
2.Reporting Limits: The consensus was
that results should be reported down to
the limit of the blank (LOB) that is 3 ng/L.
3. It was agreed that 14 ng/L, the 99th
percentile of hs-cTnT in healthy
individuals should be employed as the
upper reference limit (URL).
39

Reference population study included


616 apparently healthy volunteers and
blood donors aged between 20 and 71
years. Exclusion criteria applied to the
healthy volunteers were diabetes,
renal impairment, coronary arterial
disease, and cardiac structural
abnormalities (Echocardiogram
assessed).
Professor Giannitsis

40

It was agreed that


4. Clinical Significance this new hscTnT assay will enable more rapid
diagnosis of MI but will also increase
the detection frequency of Tn
elevations not due to ACS
5. Serial Measurements at least two
measurements of hs-cTnT are
essential to satisfy the UDMI. The first
sample to be collected on presentation
and the second, 6 hours later.
41

It was agreed that


In an evolving MI, hs-cTnT would
be expected to rise above >14
ng/L within the first 6 hrs after
presentation with a delta change
of at least 100%
A delta change of <20% within
6 hrs was not consistent with an
acute event.
42

8. Report Comments
It was suggested that
interpretative comments that
accompany hs-cTnT results
should be harmonised. Time
constraints did not allow
consensus to be reached
43

44

Laboratorians in Norway
have recommended not using the 99th
percentile as the cutoff for MI, but rather a
higher level of 0.03 g/L. This is to avoid
over-diagnosis of MI, a particular concern
in elderly patients, many of whom will have
normal values higher than 14 ng/L
circulating, explained Omland.
45

Of importance, a negative
sensitive troponin test will have
a high negative predictive
value, and may thus serve as
an exclusionary test early in the
diagnostic process.
46

As multiple conditions are


associated with Tn elevation,
pretest likelihood of disease,
clinical presentation and serial
testing will become increasingly
important for identifying those
patients with true acute coronary
syndromes
47

According to the hs-cTnT assay,


all of the ESRD patients had
elevated cTnT concentrations at
least once during the follow-up.
48

49

50

Ecco la ns
proposta di
referto
51

52

53

54

55

56

57

58

59

60