Why communication is key in transition to high-sensitivity cardiac troponin

My name is Rob Christenson. I work at the University of Maryland School of Medicine in Baltimore, Maryland. So cardiac troponin is an absolutely essential part of laboratory measurements in any hospital that takes care of heart patients, which is virtually every hospital. It's important because it's the very cornerstone for the diagnosis of myocardial infarction, and also important for monitoring cardiac injury of any sort.

So, over the past 25 years or so, we've gone through several generations of cardiac troponin, and the move to high-sensitivity cardiac troponin is another really important step of this evolution towards better biomarkers. So with this, we've always had blind spots for cardiac troponin where we would measure at presentation, then several hours later, but we had no idea what the action was biologically between the time of the first sample and the second sample.

Now, we can take these samplings much more close together temporally and so we don't have nearly the blind spot we used to. And the outcome of this is going to be the ability to make an earlier diagnosis to either rule in or rule out myocardial infarction so that we can get the patients in the right care path for their recovery.

So, with the transition to high-sensitivity cardiac troponin, we all know that change is difficult for everyone. So if I had to give one sort of a bit of advice about the transition to high-sensitivity cardiac troponin, I would say it has to be communication. Identification of folks that are stakeholders, locating champions on the clinical side of things in emergency medicine, among hospitalists, among the cardiologists, of course, all stakeholders in the system ,so that we can all work together toward developing and tailoring our educational materials to hit the spot when it comes to their specialty.

So, sex-specific cut-offs have been, you know, one of the possible benefits of moving to a high-sensitivity cardiac troponin assay. There's been a lot of controversy about it. The controversy lies in the fact that in normal, certainly, women have lower cardiac troponin values than men do.

But when they're having... but they also have their myocardial infarctions 10 years later than men do. So it turns out that there may not be such a big difference in cardiac troponin levels when you compare younger men to women that are older when they have their attack.

However, we certainly want to... women have been an underserved population for a long time and if we can improve that sensitivity of detection by moving to sex-specific values, then we ought to do so. So the main takeaway points for the high U.S. study are that they'll stand the test of time. The sizing of the study was perfectly appropriate, the conduct of it more or less in all comers, a study as close as we the investigators could make it.

The data that was collected, even if algorithms in the future of how we interpret cardiac troponin high-sensitivity change, the study is robust, and we'll be able to accommodate such changes in interpretation. But for the short run, it's going to be exactly what we wanted it to do and has gotten through the rigors of FDA, and any future issues that we want to take on with this study, I think we'll be very well appointed by the repository of samples that we have put away.

So, what keeps me coming to work every day is the fact that I feel like I'm the luckiest person anywhere. I just have... this was I think what I was intended to do. Not that I'm particularly spiritual, but that I just feel very fortunate. I'm getting up in those more senior years so you really wonder what the next step is, and I'm just having so much fun right now more than any time in my career.

So that will be a big challenge for me is to find something else that I enjoy nearly as much as I enjoy Laboratory Medicine.