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Tests for biomarker may diagnose heart attack within hours
December 27th, 2011
04:06 PM ET

Tests for biomarker may diagnose heart attack within hours

One of the most common reasons people go to the emergency room is for serious chest pains. Time is crucial when someone is having a heart attack.  If doctors don't make a diagnosis quickly, it can mean the difference between life and death.

Now, there may be a new tool to help ER doctors make a quicker diagnosis.  A new highly sensitive test can detect troponin, a protein in the muscle tissue, according to new research in this week's Journal of the American Medical Association (JAMA).  According to cardiologists, the higher the levels of troponin, the more likely it is a person will have a heart attack. If tropin isn't present, the likelihood of a heart attack is much smaller.

Researchers say this new test could also help physicians monitor patients who present with chest pains but no heart attack symptoms in the hours after being admitted to the hospital.

"Early identification of individuals at high and intermediate risk for myocardial ischemia (insufficient blood flow to the heart muscle) is crucial because they benefit the most from early and aggressive treatment," said the study's authors.

Those who evaluated the procedure commented that the key to the new test, over other troponin tests on the market, is its sensitivity. "Highly sensitive troponin assays (tests) have been developed recently that reliably assess troponin levels in more than 50 percent of the general population. The reliable detection of very low troponin concentrations using these new highly sensitive assays in the acute setting might pose a challenge in everyday clinical practice," explained the study authors.

The research, conducted out of the University Heart Center Hamburg, Germany, evaluated the diagnostic performance of the newly developed highly sensitive troponin I test (hsTnI) compared with another, less sensitive troponin test (cTnI) and how well and how quickly they diagnosed a heart attack.

The study included 1,818 patients with cardiac issues such as high risk of heart attacks or angina and who were enrolled at chest pain units in Germany from 2007 to 2008.

Out of all the patients in the study, 22.7% (413 patients) had acute MI. Both hsTnI and cTnI were superior to the other evaluated diagnostic biomarkers in detecting these coronary problems. But investigators found the hsTnl test was more sensitive to the protein biomarker in patients who were just showing signs of a possible heart attacks than the cTnl test. The hsTnl test was also almost 100 percent accurate (98.2%) in patients who were tested within three hours of entering the ER.

"The shortcoming of conventional troponin assays (test) with low sensitivity within the first hours after chest pain onset led to the evaluation of various so-called early biomarkers in the diagnosis of MI. In our study, the diagnostic information of hsTnI was superior to all other evaluated biomarkers alone, " noted the German authors.


soundoff (46 Responses)
  1. TECHNOLOGY

    THIS MEDICAL INFORMATION USED FOR ITS SOUL PURPOSE ITS INTENDED TO BE WILL HAVE A POSITIVE EFFECT ON PEOPLE HAVING A ONCOMING MEDICAL SIGN OF A HEART ATTACK IF TREATED IN A TIMELY MANNER!

    December 27, 2011 at 18:16 | Report abuse | Reply
  2. Katie

    Was this test done on men AND women or just men?

    December 27, 2011 at 20:14 | Report abuse | Reply
    • Texas Doc

      It's been done on everyone with chest pain from 18 to 108 years of age in ER's for decades. I'm not sure why this is even posted. I bet if CNN did a search, they did the same article before.

      December 27, 2011 at 21:10 | Report abuse |
    • Ash

      Texas Doc: they are talking about a new assay to detect troponin that is more sensitive than the old assay, not saying that checking troponins is novel

      December 27, 2011 at 21:34 | Report abuse |
    • JS

      Texas Doc – I imagine that the news is that a newer, more sensitive test for troponin has come out. Not really that news-worthy for the general public

      December 27, 2011 at 21:38 | Report abuse |
    • craig

      @JS

      I suspect that if it was you suffering chest pains, and you knew there were better tests available that MIGHT help ensure you get appropriate help you'd think it was quite news-worthy. Then again, perhaps not. Some of us are at an age where we actually consider such things. We're no longer young, and no longer immortal.

      December 28, 2011 at 07:21 | Report abuse |
  3. re; TECHNOLOGY

    IT IS SPELLED "SOLE" NOT "SOUL" DUMBA**

    December 27, 2011 at 20:28 | Report abuse | Reply
    • Darwinmonkey

      TECHNOLOGY spelled it right with "soul". All technology has come jesus christ, the soul fountain of truth and light, and sacntified by the holy spirit. Without it no life would be possible. 🙂 (that was sarcasm)

      December 28, 2011 at 06:42 | Report abuse |
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      October 11, 2012 at 19:48 | Report abuse |
  4. heartattackman

    To me this article is such B*lls*it. If im not mistaken troponin is the first thing that is secreted if your heart is suffering from stress or damage (like from a heart attack). High blood pressure can cause increased levels of Trop in your blood....the first thing a hospital will check for in the blood is high Troponin if you come in with chest pains.........if the test above 12 (if im not mistaken) by law the ER has to admit you because your having a mild heart attack (or irreversalbe damage to the muscle).....the info in this story is in practice at ever hospital......

    the tragedy is that this isnt covered on your annual physsicals in most HMOs.........for prevtative care. They only test you AFTER your having chest pains. God forbid American doctors actuall practiced "preventative medicine" becasue you cant make money if the person aint sick....

    December 27, 2011 at 20:32 | Report abuse | Reply
    • medic

      1) troponin is not released from high blood preassure (3rd sentence) so you are mistaken.
      2) 2nd paragraph. heart attacks are only covered on you annual physical exam IF YOU ARE HAVING A HEART ATTACK IN YOUR PCP's OFFICE! It would be nice, but most heart attacks happen on one of the other 364 days of they year (when you are not having a physical exam). Troponin tests for a Heart attack with in the past few hours, it is not predictive of a comming event.

      December 27, 2011 at 20:44 | Report abuse |
    • med student

      troponin is not a screening test!

      December 27, 2011 at 21:40 | Report abuse |
    • ERMD

      Yes, heartattackman, you ARE mistaken. "if the test above 12 (if im not mistaken) by law the ER has to admit you because your having a mild heart attack...." There is no law that says this.

      In addition, troponins can be elevated for a variety of reasons, from renal insufficiency to congestive heart failure to a shark attack. An elevated trop does not always mean you are having a heart attack.

      December 27, 2011 at 22:42 | Report abuse |
    • jim d.

      "by law the ER has to admit you" really? crae to enlighten up with the text of the "law" or a link to the text of the "law". you are making this up. thanks for playing......

      December 27, 2011 at 22:55 | Report abuse |
  5. augustghost

    This test has been around for years. NOT a new test... Catch up with the times.

    December 27, 2011 at 20:56 | Report abuse | Reply
    • StatusQuoSkeptic

      And what is the sensitivity of the test that has been around for years?

      All these docs don't want to use a better diagnostic because they just want to saok the taxpayer for more "observation time" @$5000 a day or more in the ER. Who needs new diagnostics when you can rob the taxpayer blind sticking with the status quo?

      In every other industry, technology gets adopted and costs driven out of the system rapidly. But doctors don't like to change, so we all bear the costs...

      December 28, 2011 at 00:38 | Report abuse |
  6. Texas Doc

    This test has been around for over 15 years, used widely and routinely for over 10 years. They have hand held devices for offices and back of ambulances now. This article was timely about 17 to 20 years ago! Is it a joke or a really really slow news day.

    December 27, 2011 at 21:01 | Report abuse | Reply
    • StatusQuoSkeptic

      And how many of your patients have spent the night in the ER despite not having had a heart attack? If the existing test is so good, why do they? The diagnostic should provide cover for liability...

      December 28, 2011 at 00:42 | Report abuse |
  7. rawr

    This test has NOT been around for a few years now. If you read the article, it's talking about a new high sensitivity test. The current standard of care is 3 trops with 6 hours in between each one because of the low sensitivity of the current test. This high sensitivity test allows for the detection of slightly elevated levels of Trop within 3 hours vs. over 18 hours. That's the key difference

    December 27, 2011 at 21:04 | Report abuse | Reply
    • Texas Doc

      This new level of sensitivity is not new. I've used it for over 5 years.

      December 27, 2011 at 21:10 | Report abuse |
    • rawr

      Texas doc: Is standard of care in Texas also 3 trops with 6 hours in between?

      December 27, 2011 at 21:16 | Report abuse |
    • Leo

      I don't know about Texas, but I've been an EMT in New Hampshire, and I've been taken to the ER in Kansas with chest pains (it was pericarditis related to an auto-immune condition, not a heart attack). My wife is a medical technologist who RUNS these tests, also in Kansas. And yes, these tests (the ones that detect troponins with just a single blood draw) are standard practice for chest pain patients in ER's. They can rule out a heart attack with a blood test in less than a half hour. And yes, they are that sensitive. I currently work on the hospital campus with one of the best heart hospitals in the entire country, and definitely the best in the midwest. They've got all the latest technology. This test? Is old news.

      December 27, 2011 at 22:51 | Report abuse |
    • rawr

      Ah, interesting, I work in an ED in New York. We're still using the 3 trops with 6 hours in between as our standard. We don't use the high sensitivity test. Stupid NYS

      December 27, 2011 at 23:17 | Report abuse |
  8. forsingle

    Bigtalls.c0m..a nice club for tàll people to date. You need not to be beautiful or handsome,if you are over 5'8", as long as you are tàll, you are very popular here.

    December 27, 2011 at 21:52 | Report abuse | Reply
  9. Houston ER Doc

    Even in this study, comparing contemporary troponin and "highly sensitive" troponin, the sensitivities are about the same at 3 hours. The problem is that I'm sure this new "highly sensitive" troponin is much more expensive than the plain old troponin. Question is when compared the "rapid rule out" protocols that don't require 24 hours of observation, are they really better and is the cost of the test saving any money compared to a few extra hours of observation?

    And of course, here's the other problem they don't tease out – all the false positives currently problematic with troponin from patients with renal failure. I'm sure the "highly sensitive" troponin will be even more falsely positive.

    December 27, 2011 at 22:50 | Report abuse | Reply
    • StatusQuoSkeptic

      I spent an overnight stay in the ER 2 years ago from bad arrythmia and chest pain. Costs were $5K plus. If all this has been around for so long, why are you robbing the people with overnight ER stays? And don't give me that liability crap. If the troponin test had the sensitivity and predictive power you claim, Cardio / ER docs are defrauding the taxpayer. Else, you are not being intellectually honest about the current state otroponin testing.

      Personally, I would think that HS troponin would be better able to discriminate MCI from renal issues over time series analysis with smaller time intervals. As to the doc who suggested more hours of observation, each hour costs vastly more than the incremental cost of the diagnostic... just another doc trying to protect the status quo of waiting our taxpayer dollars.

      December 28, 2011 at 00:28 | Report abuse |
    • cinnabunz

      statusquo - Houston ER doc is completely right.The sensitivities are about the same at 3 hours. The PPV of cTnI is even better at 0 and 3 hours. The NPV of cTnI, while worse, is worse by only 0.7%. In the real world, these tests are also accompanied by EKGs at 0 and 3 hours as well, which also increases sensitivity and specificity. Not to mention ckmb. In practice, because of likely the negligible difference beteween cTnI and hsTnI, I don't see the reason to put this into real-world usage until more studies come out. Especially like what Houston ER doc says, with renal failure pts that come in with elevated trops. This happens all the time.

      This isn't about trying to get tax payer money. It's about getting the job done right and as efficient as possible. Something tells me you don't work in the health field.

      December 29, 2011 at 22:47 | Report abuse |
  10. VA_LABRAT

    Veteran's Admininistration Laboratorys have been doing Troponins for years now.

    December 27, 2011 at 23:10 | Report abuse | Reply
  11. ComeOnMan9

    C'mon techs get ready for the new test of the day. These giblet heads will order tests up the ying yang and wont even stop to read the results. Rake cTnl cartridges, reagent buckets, and slides in the trash now. Order up all the high sensitvity Troponin test you can find and sit back and laugh, ha!

    December 28, 2011 at 00:47 | Report abuse | Reply
  12. E

    Ironic that a naysayer would be from Texas, when some of the groundbreaking work on the HIGH SENSITIVITY assay comes from ... Texas. Or Texas Doc apparently missed out on hs-troponins, one of the hottest topics at cardiology conferences for the last year. That, or s/he should look a little bit into lab assay specifics and lab testing. To practice medicine without doing so ... that's just scary.

    1) Regular troponin assays cannot detect anything below the order of 0.1 ng/mL. After a heart attack, it takes at least 3-4 hours for troponins to rise to this threshold (hence, why a bunch talked about keeping people up to 12 hours – 3 every 6, or 3 ever 8 – to re-test them).

    2) The new high-sensitivity assays have pushed the detection of troponins down to 0.003 ng/mL. We're talking something about 100x more sensitive. Meaning, the assay will detect a rise in levels after a heart attack much sooner than regular assays.

    3) RAPID troponin tests are NOT any more sensitive than regular assays. They just give the results faster.

    4) It has great potential as a screening tool. Several large epidemiologic studies, such as the Dallas Heart Study, have shown that it can predict who will GENERALLY go on to have heart problems in the future. The race is on to validate the new assay under other situations.

    5) You must be joking if you claim to do the HS version in the States. It's not approved here except for research purposes like the above. It's available commercially only in Europe.

    December 28, 2011 at 06:23 | Report abuse | Reply
    • E

      Correction:
      "(hence, why a bunch talked about keeping people up to **24 hours – 3 **'troponin tests' every 6 **hours, or 3 **'troponin tests' **every 8 **hours – to re-test them *'and check for a trend')

      December 28, 2011 at 06:50 | Report abuse |
    • E

      One last thing:

      Rapid tests are not the same as high-sensitivity tests. The high-sensitivity tests are being used in the Dallas Heart Study and other studies, with papers coming out just in the last few years in top-tier medical journals.

      December 28, 2011 at 07:03 | Report abuse |
    • ali

      Oh..ok..that makes more sense (didn't read the entire article)..thanks

      December 28, 2011 at 21:49 | Report abuse |
    • ali

      Oh..ok..that makes more sense (didn't read the entire article)..good information..thanks

      December 28, 2011 at 21:52 | Report abuse |
  13. savelives

    how about we try and prevent a heart attack first? All this does is diagnose a heart attack after it happens! There is a technology that has been around for several years that will identify irregularities and save lives – all it needs is more publicity. Doctors own this company, not marketing professionals...check it out. This life saving technology is called MTWA – Microvolt T-Wave Alternans by Cambridge Heart. Some insurance companies are now actually covering this test. DON'T have unnecessary implants or procedures if you or a loved one doesn't have to. Knowledge is power.

    December 28, 2011 at 07:05 | Report abuse | Reply
  14. Ronald Mcloughlin

    As a heart patient, this is nothing new. I've been having troponin tests for at least 3 years or longer.

    December 28, 2011 at 07:58 | Report abuse | Reply
  15. ali

    Ummm...I'm a telemetry RN...troponin levels have been use for years as one indicator of a heart attack. I don't understand the point of this article.

    December 28, 2011 at 21:42 | Report abuse | Reply
  16. ComeOnMan9

    As a health care consumer, I get all excited about these faster better sensitivity tests and then I see how they are actually used. I get orders for full on cardiac workups on anybody greater than 35 owning a heart. What a waste man.

    December 29, 2011 at 00:51 | Report abuse | Reply
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  17. ds123

    I love the amateur wannabe doctors coming on here saying the troponin test has been around for years. THAT IS OBVIOUS. No one is trying to pull the wool over our eyes and pretending like we haven't been testing for troponins for DECADES.

    The news here is there's a newer, sensitive test for troponins.

    December 29, 2011 at 11:24 | Report abuse | Reply
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