Increasingly Sensitive Assays for Cardiac Troponins A Review
Increasingly Sensitive Assays for Cardiac Troponins A Review
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DOI：
10.1001/jama.2013.5809
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发表时间：
2013-06-05
影响因子：
120.7
通讯作者：
de Lemos, James A.
中科院分区：
文献类型：
--
作者：
de Lemos, James A.
心肌肌钙蛋白因其对心肌损伤的高敏感性和特异性而成为诊断心肌梗死的首选生物标志物。然而，不同于急性冠脉综合征（ACS）的急性和慢性疾病通常会导致肌钙蛋白水平的小幅升高，关于此类疾病患者的护理管理的数据很少。最近开发的高灵敏度肌钙蛋白检测可能会导致非acs条件下可检测到的肌钙蛋白水平的比例大幅增加。采用高灵敏度检测的新算法，结合基线肌钙蛋白值和1 - 2小时内的值变化，可以快速排除心肌梗死，并有助于解决特异性问题，但必须在适当的目标人群中进行验证。通过高灵敏度的检测方法增强对极低肌钙蛋白水平的检测，使肌钙蛋白检测的几个潜在新适应症成为可能，包括在门诊环境中，对低水平慢性心肌损伤的评估可能会加强心衰和心源性死亡的风险分层。
Cardiac troponins are the preferred biomarkers for diagnosis of myocardial infarction because of their high sensitivity and specificity for myocardial injury. However, acute and chronic conditions distinct from acute coronary syndromes (ACS) commonly lead to small elevations in troponin levels, with few data available regarding management of care for patients with such conditions. Recently developed highly sensitive troponin assays will likely lead to a substantial increase in the proportion of detectable troponin levels attributable to non-ACS conditions. Novel algorithms with highly sensitive assays, incorporating baseline troponin values and changes in values over 1 to 2 hours, may allow rapid exclusion of myocardial infarction and help to address specificity concerns but must be validated in appropriate target populations. Enhanced detection of very low troponin levels with highly sensitive assays has made feasible several potential new indications for troponin testing, including in the ambulatory setting, where assessment for low-level chronic myocardial injury may enhance risk stratification for heart failure and cardiac death.