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 cardiac troponin assay utility in early detection of acute coronary syndrome
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cardiac troponin assay utility in early detection of acute coronary syndrome


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  • 1. By Dr.Anup BhandariJR 1 ,Department of Pathology, S.R.T.R.M.C.Ambajogai
  • 2. • “A is a substance used as an indicator of a biologic state.• It is a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”• --Wikipedia
  • 3. • preexisting ST-segment • Gastroesophageal elevation because of disease ventricular aneurysm or • Pericarditis, pleuritis by Q waves • Chest wall syndromes• pacemaker rhythm • Pulmonary embolism• or preexisting or newly • Aortic aneurism developed bundle • Herpes zoster branch blocks (BBB).
  • 4. • Diagnosing AMI/ACS• Detecting myocardial damage whether due to AMI or other cardiac process• Risk-stratifying patients• Commenting on Prognosis – In ACS, pre and post PCI/reperfusion therapy – Renal Disease• Stressing interns, confusing residents and worrying cardiology fellows
  • 5. • CK (CPK)• CK-MB• Troponin-I/T• LD (LDH)• Myoglobin• ALT/AST• Others
  • 6. Test Normal Range CK or CPK Normal 25-170 U/L Creatinine Phosphokinase CK-MB < 5% MB Myoglobin Normal < 85 ng/ml LDH Normal 100-200 U/L (Lactate LDH-1 -5 dehydrogenase) LDH- 1 is found primarily in heart muscle and red blood cells. Troponin Normal < 0.01ng/ml cTnT May be elevated by CRF Troponin I Normal < 0.1 ng/ml cTnI Not elevated by CRFMost cardiac specific
  • 7. Timing SummaryTEST ONSET PEAK DURATIONCK/CK-MB 3-12 hours 18-24 hours 36-48 hoursTroponins 3-12 hours 18-24 hours Up to 10 daysMyoglobin 1-4 hours 6-7 hours 24 hoursLDH 6-12 hours 24-48 hours 6-8 days
  • 8. • Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following:• ischemic symptoms;• development of pathologic Q waves on the ECG;• ECG changes indicative of ischemia (ST segment elevation or depression);• coronary artery intervention (e.g., coronary angioplasty)
  • 9. • Troponin is a complex of three regulatory proteins that is integral to non-smooth muscle contraction in skeletal as well as cardiac muscle• Troponin is attached to the tropomyosin sitting in the groove between actin filaments in muscle tissue• three subunits, TnC, TnT, and TnI – Troponin-C (calcium ions) – Troponin-T (tropomyosin) – Troponin-I (actin)
  • 10. :– Cutoff is set at 99th percentile of a normal reference population, variation of less than 10%– Since troponin levels are virtually undetectable in normal subjects, this 99th percentile corresponds to <0.01(cTn T) ,0.1(cTn I) – -heparin in sample can result in lowered values
  • 11. Troponin Early Peak (Hrs) Duration Specficity Sensitivity Rise(hrs) (Days) Tn T 3-4 10-24 10-24 80% >98% Tn I 4-6 1-24 4-7 95% >98%• Therefore it has good utility for retrospectively diagnosing AMI• Remember, CK-MB returns to baseline by
  • 12. chronic diseasedetectable even if not acute levels myocardial damage72-96 hour peak TI infarct size valuetime to peak a lower cardiac event-troponin >11 free survival rate and with increased risk hours of reinfarction
  • 13. heart failure, myocarditis and pericarditis,cardiomyopathy, cardiac contusion, defibrillation andinternal or external cardioversion,cardiac procedurescritical illnesses such as sepsis, Several toxins andvenoms, Carbon monoxide poisoning , primary pulmonaryhypertension, pulmonary embolism and acuteexacerbations of chronic obstructive pulmonary disease(COPD), Seizures, end-stage renal disease, Strenuousendurance exercise
  • 14. • SOS• repeated at 2 and 72 hours later• Assay times range from 5 to 30minutes• TAT<60 min• cTn T >0.1 ng/ml• cTn I >1.0 ng/ml
  • 15. An immunoassay is a biochemical test thatmeasures the concentration of a substance inserum or urine, using the reaction of aspecific antibody (often monoclonal Ab) orantibodies to bind to its antigen. To determinea numerical result (as in cardiac biomarkers),the response of the fluid being measuredmust be compared to standards of a knownconcentration. One of the most commonmethods is to label either the antigen or theantibody with an enzyme (EIA), radioisotope(RIA), magnetic labels (MIA) or fluorescence
  • 16. False- False-positive negative interference of heterophile circulating IgG- antibodies class autoantibodies fibrin clots microparticles in specimens analyzer malfunctions
  • 17. IMA • Increases within 6-10 min • Used with ECG Or troponinGPBB • Peaks earlier than CK-MB • More sensitive early markerMPO • Released from WBC granules • Atheromatous plaque instability
  • 18. RBC GP1 • Inverseactivity relationship • Eroded orPAPP-A ruptured plaque
  • 19. Edge over other biomarkers• improved time dependent sensitivity and improved specificity• first peak value 40 times the detection limit Vs CK-MB only 6-9 times• prognostic value of troponin in unstable angina,reperfusion therapy• Corelates with infarct size• Reducing false positives