Evaluation of analytical performance of immunoassay methods for cTnI and cTnT: From theory to practice

• Published in: Advances in clinical chemistry Vol. 93; p. 239
• Main Authors: Clerico, Aldo, Zaninotto, Martina, Padoan, Andrea, Masotti, Silvia, Musetti, Veronica, Prontera, Concetta, Ndreu, Rudina, Zucchelli, Giancarlo, Passino, Claudio, Migliardi, Marco, Plebani, Mario
• Format: Journal Article
• Language: English; Japanese
• Published: United States 2019
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Biomarkers - blood; Early Diagnosis; Female; Humans; Immunoassay - methods; Male; Sensitivity and Specificity; Troponin I - blood; Troponin T - blood; Cardiac troponins; cTnI; Reference population; High sensitivity methods; Immunoassay methods; Quality specification; cTnT; Analytical performance
• ISSN: 2162-9471; 2162-9471
• DOI: 10.1016/bs.acc.2019.07.005

Current guidelines worldwide recommend cardiac troponins I (cTnI) and T (cTnT) as the biomarkers of choice for the differential diagnosis of acute coronary syndrome (ACS), and the measurement of the 99th upper reference population limit (URL) value for cardiac troponins, with an imprecision of ≤10 CV%. Measuring the 99th URL of cTnI and cTnT is a challenging analytical task due to low biomarker concentrations present in healthy subjects. Therefore, since the year 2006, several manufacturers have established new generation cTnI and cTnT immunoassays with an improved analytical sensitivity in accordance with the quality specifications described in international guidelines, the more recent of which state that only immunoassays that meet the required quality specifications should be considered "high-sensitivity" methods. For the early diagnosis of ACS, and for the stratification of cardiovascular risk in cardiac patients and the general population, high-sensitivity methods should be employed. It is therefore important for laboratory professionals and clinicians to gain a thorough understanding of the analytical performances of immunoassay methods for cTnI and cTnT, especially at low to normal concentration ranges. The aim of the present study was to analyze critical aspects related to definition, analytical performance, pathophysiological interpretations, and the clinical relevance of high-sensitivity cardiac troponin assays.