In recent years, the development of detection methods for cTnI and cTnT with progressively increasing analytical sensitivity, which can detect myocardial necrosis of microscopic size, has led to a revolution in the definition of acute myocardial infarction. According to the latest definition of myocardial infarction, the measurement of cardiac troponin plays a central and essential role in its diagnosis.

his new definition of AMI is having a significant clinical (but also social and economic) impact, as, since its introduction, diagnosed cases of infarction have increased by 20–40%, compared with when the World Health Organization (WHO) definition of AMI, published in 1973, was used. The WHO definition considered three distinct criteria for the diagnosis of myocardial infarction:

• The presence of typical ischemic symptoms

• The presence of typical electrocardiographic signs

• The typical upward/downward trend in the values of the so-called cardiac enzymes (AST, CK, and LDH). 

However, only two of these three criteria were necessary for the diagnosis. According to this definition, in a patient with typical symptoms (anginal pain) and electrocardiographic (ECG) alterations (such as ST-segment elevation), the IMA diagnosis is established. In patients with ST-segment elevation myocardial infarction (STEMI), the cTnI or cTnT assay can only confirm the diagnosis and be used for monitoring and prognosis. The cardiac troponins measurement becomes essential for diagnosing patients with typical ischemic symptoms without ECG alterations; in these patients, if they have an altered troponins kinetics, a diagnosis of non ST elevated myocardial infarction (NSTEMI) is made.

The most evident and relevant clinical advantage of the new methods for measuring cTnI and cTnT with higher analytical sensitivity is the reduction of the time required to diagnose AMI. Indeed, from diagnostic algorithms based on serial sampling on admission and after 12–24 hours by the first generation methods (1990–2002), there has been a gradual shift to more rapid diagnostic algorithms (6–12 hours in the years 2003–2007), which, by methods at high analytical sensitivity, require a second sampling 3 hours after admission (Fig. 1). Finally, in the European Society of Cardiology (ESC) guidelines published in 2015, and subsequently updated in 2018, an assessment of biomarker kinetics involving a second sampling (T1) after 1 hour is suggested.

Fig1. Algorithm for diagnosing acute myocardial infarction (AMI) in accordance with national guidelines. 3-hour algorithm for the diagnosis of IMA NSTEMI, using a highly sensitive measurement method. Ischemic setting: patient with medium-high risk of the acute coronary syndrome, without a pathognomonic ECG for STEMI. The diagnosis of NSTEMI is ascertained when at least in a sample collected within 3 hours of admission, a troponin (Tn) value higher than the 99^th percentile of the reference population is found and the change from the base line value (admission to the Emergency Department) is greater than 50%. (Copyright EDISES 2021. Reproduced with permission)

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اخبار العتبة العباسية المقدسة

مع وصول الزيارة ذروتها.. العتبة العباسية المقدسة تستنفر ملاكاتها لخدمة زائري مرقدي الإمامين العسكريين (عليهما السلام)

قسم الشؤون الطبية: الخطة الخدمية في سامراء تضمنت مشاركة نحو ٥٠ متطوعًا من ثلاث محافظات

عبر محطات الإجابة عن الاستفتاءات الشرعية مشروع التبليغ الحوزوي يقدّم خدماته لزائري مدينة سامراء

قسم حفظ النظام يشارك في تأمين زيارة الإمام الحسن العسكري (عليه السلام) بمدينة سامراء

المزيد

الآخبار الصحية

دون آثار جانبية.. زيت عشبة طبيعية قد يعالج القلق

"ليكانيماب".. علاج الزهايمر يطرح رسميا في السوق الألمانية

متى يجب تنظيف الأسنان في الصباح.. قبل أم بعد الإفطار؟

ارتفاع الوفيات.. منظمة الصحة تدق جرس الإنذار بشأن الكوليرا

المزيد

الآخبار التكنلوجية

أكبر مشروع طاقة رياح في نصف الكرة الجنوبي يحقق إنجازين جديدين

5 أمور لا تفعلها أثناء تشغيل مكيف سيارتك

ضوء إدارة المحرك: أسئلة مهمة لفهم عمله ومعانيه

"واتساب" يطلق خاصية جديدة لكتابة الرسائل بالذكاء الاصطناعي

المزيد

مواضيع ذات صلة

sputum cytology

sodium (Na), urine

Sims-Huhner test (Postcoital test, Postcoital cervical mucus test, Cervical mucus sperm penetration test)

Quality Specifications of Troponin Measurement Methods

Hyperkalemia

sickle cell screen (Sickledex, Hemoglobin [Hgb] S test)

sexually transmitted disease testing (STD testing)

serotonin (5-hydroxytryptamine, 5-HT) and chromogranin A

Hypokalemia

Hypernatremia

Hyponatremia

semen analysis (Sperm count, Sperm examination)