Exploring strategies to rapidly identify false positives in high-sensitivity cardiac troponin I assay: A prospective
Anthony Desaegher1, Victor Marin1, Marie-Christine Beauvieux2
1Department of Biochemistry, Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
Insights
High-sensitivity cardiac troponin I assays can yield false-positive results due to analytical interferences. A new algorithm helps identify these interferences, improving diagnostic accuracy for myocardial injury.
Area of Science:
- Cardiology
- Clinical Chemistry
- Biomarker Analysis
Background:
- Cardiac troponin is a key biomarker for myocardial injury and acute coronary syndrome diagnosis.
- Elevated cardiac troponin without clear cardiac origin suggests interfering factors.
- High-sensitive cardiac troponin immunoassays, despite high performance, are prone to interferences causing false-positives.
Purpose of the Study:
- To investigate and identify analytical interferences leading to false-positive results in high-sensitivity cardiac troponin I measurements.
- To develop and propose an algorithm for detecting high-sensitivity cardiac troponin I false-positives.
Main Methods:
- Prospective evaluation of 15 patients with suspected false-positive high-sensitivity cardiac troponin I results (out of 8129 hospitalized patients).
- Utilized techniques including serial dilutions, antibody-binding tubes, and alternative immunoassays (cardiac troponin I and T).
Main Results:
- Analytical interference was identified in the high-sensitivity cardiac troponin I assay in 12 out of 15 suspected cases.
- Demonstrated the presence of interfering factors affecting troponin measurements in a significant subset of patients.
Conclusions:
- An original algorithm was developed to identify high-sensitivity cardiac troponin I false-positives.
- The algorithm aids clinicians in making informed decisions, avoiding erroneous interventions due to assay interferences.
Background:
Cardiac troponin is the pivotal biomarker of myocardial injury, playing a central role in the diagnosis of acute coronary syndrome and various clinical situations. Nevertheless, challenges arise when patients exhibit elevated cardiac troponin levels in the absence of evident cardiac origin, as evidenced by extensive cardiac exploration, which suggests the presence of an interfering factor. Despite the high performance of high-sensitive cardiac troponin immunoassays, these tests remain susceptible to interferences that may lead to false-positives.
Methods:
In the period between July 2021 and July 2024, 8129 patients were hospitalized in the cardiology departments of Bordeaux University Hospital with positive results for high-sensitivity cardiac troponin I. Among them, 15 patients were suspected of having false-positive results, based on clinical and biological observations.
Results:
In this subpopulation, we evaluated prospectively various techniques, including serial dilutions, antibody-binding tubes, and alternative immunoassays (for cardiac troponin I and T) with the objective of identifying any potential analytical interference in their high-sensitive cardiac troponin I measurements. Our investigations revealed that 12 out of 15 suspected cases exhibited an interference on the high-sensitive cardiac troponin I assay.
Conclusion:
In conclusion, we propose an original algorithm designed to identify high-sensitive cardiac troponin I false-positives. This algorithm can help clinicians to make prompt and informed decisions about patient care, and to avoid erroneous clinical interventions that may result from such interferences.
More Related Videos
09:23Using Extraordinary Optical Transmission to Quantify Cardiac Biomarkers in Human Serum
Published on: December 13, 2017
07:40Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training
Published on: October 10, 2019
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:27Myocarditis II: Clinical features and Diagnostic Tests
01:30Acute Coronary SyndromeI: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and clinical manifestations