Variability and Error in Cardiac Troponin Testing: An ACLPS Critical Review

Am J Clin Pathol. 2017 Oct 1;148(4):281-295. doi: 10.1093/ajcp/aqx066.

Abstract

Objectives: To provide a comprehensive overview of the complexities associated with cardiac troponin (cTn) testing. An emphasis is placed on the sources of error, organized into the preanalytical, analytical, and postanalytical phases of the testing pathway. Controversial areas are also explored.

Methods: A case scenario and review of the relevant literature describing laboratory considerations involving cTn testing are described.

Results: Advanced comprehension of the specific assay used in a given laboratory is necessary for optimal reporting, utilization, and quality monitoring of cTn.

Conclusions: cTn assays are reliable diagnostic tests for acute myocardial infarction, but understanding their limitations is required for appropriate result interpretation.

Keywords: Analytical sensitivity; Cardiac troponin; Error; False negative; False positive; Preanalytical; cTnI; cTnT.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Biomarkers / blood
  • Blood Specimen Collection / instrumentation
  • Blood Specimen Collection / methods
  • Blood Specimen Collection / standards
  • Female
  • Hematologic Tests / instrumentation
  • Hematologic Tests / methods
  • Hematologic Tests / standards*
  • Humans
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis
  • Pathology, Clinical / methods*
  • Pathology, Clinical / standards*
  • Troponin T / blood*

Substances

  • Biomarkers
  • Troponin T