According to the "Chinese Expert Consensus on the Clinical Application of Highly Sensitive Methods to Detect Cardiac Troponin" jointly organized by the Cardiovascular Disease Branch of the Chinese Medical Association and the Laboratory Medicine Branch of the Chinese Medical Association, the definition of high-sensitive cardiac troponin (hs-cTn) refers to the measurement of cTn using highly sensitive methods, and its detection methods have been widely used in clinical practice. cTn detection must meet the following two conditions at the same time before it can be called hs-cTn [1, 2]:
1. The 99th percentile value of the upper limit of the reference range, the CV detected at this point should reach ≤10%
2. The detection rate in apparently healthy normal people is ≥50% (first generation) ≥75% (second generation) ≥ 95% (third generation)
The difference between high-sensitivity troponin and “regular” troponin
The lower detection limit is lower
hs-cTn and cTn detect the same substance, but the sensitivity of the detection methods is different. The lower limit of detection concentration of hs-cTn is 10-100 times lower than that of ordinary cTn.
Diagnosis time is earlier
hs-cTn can help detect tiny myocardial injuries that were easily missed in the past. hs-cTn can detect a clinically significant increase 1 to 3 hours after myocardial injury, which is 3 to 6 hours earlier than traditional methods.
Compare with ordinary cTn testing, hs-cTn detection has a higher predictive value for myocardial infarction, can reduce the troponin blind zone time, and detect acute myocardial infarction earlier; at the same time, it can diagnose ACS within 1-3 hours after symptoms appear, and improve outcomes in 5% of patients with non-ST-segment elevation acute coronary syndrome (NST-ACS).
The clinical significance of high-sensitivity troponin detection
1、Early diagnosis of acute myocardial injury
2、hs-cTnI for risk stratification of acute coronary syndrome (ACS)
3、In addition to ACS, hs-cTnl can detect other heart diseases, such as cardioversion, aortic dissection, etc.
Clinical application of high-sensitivity troponin I and high-sensitivity troponin T [3]
cTnI and cTnT are widely present in the myocardium of patients, and there is a strong correlation between cTnI and cTnT. When used together in the diagnosis of patients with heart disease, they can play a complementary role and provide a more comprehensive reference for the diagnosis of patients' diseases.
References:
[1] Chinese expert consensus on laboratory testing and clinical application of cardiac troponin
[2] Chinese expert consensus on clinical application of highly sensitive method for detecting cardiac troponin
[3] Myocardial myocardial infarction in clinical diagnosis and treatment of acute coronary syndrome in primary hospitals Expert consensus on the application of calprotein detection