High sensitivity

cardiac troponin
assays
Troponin T

 1st gen assay: ELISA, 90 min, LOD 0,1

 2nd gen assay: less cross reactivity, reduced 9 min
 2000, ESC/ACC consensus : recommended
 3rd gen assay: higher linearity
 4th gen assay: lower concentration of detection
 5th gen assay (2009): high sensitivity troponin
Improved sensitivity

 More sensitive antigen binding and

detection antibodies
 Increasesin the concentration of the
detection probes on the tag Ab
 Buffer optimization
Hs-ctnt assay

 Uses fragment antigen binding (FAB) portions of

2 cTnT specific mouse Mabs directed against
epitopes in the central region of human cTnT
Hs-cTnT

 Issue: skeletal muscle cross reactivity

 Cardiac TnT differs from skeletal TnT :6-11 amino acids
 Diseased skeletal muscle  false negative result
Potential issues for troponin assays

 Circulating autoantibodies  12,7% TnI and 9,9% TnT

 ACS : prevalence autoantibodies TnI ± 20%
 Affect assay performance:
 Blockage of the immunoassay binding site
 Binding of troponin to autoantibodies  macrotroponin