Lafrenière Matthew A, Tandon Vikas, Ainsworth Craig, Nouri 'Kazem, Mondoux Shawn E, Worster Andrew, Kavsak Peter A
Department of Pathology and Molecular Medicine, Division of Clinical Pathology, McMaster University, Canada.
Department Medicine, Division of Cardiology, McMaster University, Canada.
Clin Biochem. 2023 May;115:67-76. doi: 10.1016/j.clinbiochem.2022.06.007. Epub 2022 Jun 27.
The current definition of high-sensitivity cardiac troponin (hs-cTn) assays is laboratory-based and their analytical attributes and characteristics have drawn significant attention in the literature at least partly due to the lower concentration cut-offs and changes in concentrations (i.e., deltas) employed in different algorithms and pathways to manage patient care. We propose that pre-analytical conditions such as sample type, storage conditions, and other interferences may also have a significant impact on hs-cTn concentrations and clinical management. The purpose of this literature review is to provide a summary of important pre-analytical and interference studies affecting hs-cTn concentrations. A breakdown of the literature for the major diagnostic companies providing core laboratory instrumentation (i.e., Abbott, Beckman, Ortho, Roche, and Siemens) is also provided. Finally, three cases are highlighted where knowledge of pre-analytical factors aids the hs-cTn clinically discordant investigations. This review highlights the importance of pre-analytical variables, especially storage condition, sample handling, and blood tubes used (i.e., sample type) when interpreting hs-cTn assays. Additional studies are needed to further elaborate on pre-analytical variables (i.e., centrifugation, sample type, stability) and interferences for all hs-cTn assays in clinical use, as knowledge of these variables may aid in hs-cTn clinically discordant investigations.
高敏心肌肌钙蛋白（hs-cTn）检测的当前定义是基于实验室的，其分析属性和特征在文献中引起了极大关注，至少部分原因是不同算法和患者护理管理途径中采用的浓度截断值较低以及浓度变化（即差值）。我们认为，诸如样本类型、储存条件和其他干扰因素等分析前条件也可能对hs-cTn浓度和临床管理产生重大影响。本文献综述的目的是总结影响hs-cTn浓度的重要分析前和干扰因素研究。还提供了提供核心实验室仪器的主要诊断公司（即雅培、贝克曼、奥索、罗氏和西门子）的文献分类。最后，重点介绍了三个案例，其中分析前因素的知识有助于解决hs-cTn临床不一致的调查。本综述强调了分析前变量的重要性，尤其是在解释hs-cTn检测结果时的储存条件、样本处理和所用采血管（即样本类型）。需要进一步开展研究，以详细阐述临床使用的所有hs-cTn检测的分析前变量（即离心、样本类型、稳定性）和干扰因素，因为了解这些变量可能有助于解决hs-cTn临床不一致的调查。
