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1 Washington University School of Medicine, Department of Pathology and Immunology, Division of Laboratory Medicine, Box 8118, 660 S. Euclid Ave., St. Louis, MO 63110
2 Dade Behring Inc., Chemistry/Immunochemistry Research and Development, Glasgow Business Community B700, #707, Newark, DE 19714
3 CHU Hôpital Henri Mondor, Laboratoire de Biochimie, 94 Créteil, France
4 Azienda Ospedaliera di Padova, Laboratorio Centrale, Via Giustiniani 1, 35128 Padova, Italy
5 University of Alberta Hospital, Department of Laboratory Medicine and Pathology, 4B1.24 Walter C. MacKenzie Center, 8440 112th St., Edmonton, Alberta, T6G 2B7 Canada
aAuthor for correspondence. Fax 314-362-1461; e-mail mscott{at}labmed wustl.edu.
Background: Recent guidelines for use of cardiac troponin to detect cardiac damage and for cardiovascular risk stratification have made increasingly sensitive troponin assays important. Troponin assays continue to be plagued by interferences caused by heterophilic antibodies (HAs). We evaluated the performance of a revised cardiac troponin I (cTnI) assay designed to have increased analytical sensitivity and to minimize the effect of HAs.
Methods: The revised Dade Behring Dimension® cTnI assay was evaluated according to NCCLS EP5-A at five institutions. Plasma samples from 14 309 patients were assayed by the original Dimension cTnI assay. To identify samples that may have interfering HAs, samples with values >1.4 µg/L were reanalyzed on the Dade Behring Stratus® CS cTnI assay. Samples with possible interfering antibodies were also analyzed before and after selective absorbance studies on the revised Dade Behring Dimension cTnI assay.
Results: The limit of quantification in the revised method was 0.1 µg/L with imprecision (CV) of 11–17% at 0.1 µg/L. Values correlated well with the Stratus CS cTnI method: revised = 1.06(original) + 0.01; r = 0.98, Sy|x = 0.25 µg/L). Falsely increased results consistent with myocardial infarction by the original Dimension cTnI assay and presumably attributable to HAs were identified in 0.17% of all patients with samples submitted for cTnI analysis. The revised Dimension cTnI assay eliminated the interference in 17 of 25 samples identified and greatly decreased the interference in the other 8.
Conclusions: The revised Dimension cTnI method greatly minimizes the effect of interfering HAs. It also exhibits analytical performance characteristics consistent with recent guidelines for use of this assay to detect cardiac damage.
The following articles in journals at HighWire Press have cited this article:
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  L. Wang, D. M. Bunk, H.-J. He, and K. D. Cole Removal of Inhibitory Effects in a Serum Cardiac Troponin I Immunoassay Clin. Chem., November 1, 2009; 55(11): 2055 - 2056. [Full Text] [PDF]
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A. Pfafflin Highly Sensitive Cardiac Troponin I Assay Leads to Lowered Specificity Clin. Chem., September 1, 2009; 55(9): 1749 - 1749. [Full Text] [PDF]
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C. A. Parvin and F. S. Apple The authors of the article cited above respond: Clin. Chem., August 1, 2006; 52(8): 1608 - 1609. [Full Text] [PDF]
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 A. Hays and M. N. Diringer Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage Neurology, May 9, 2006; 66(9): 1330 - 1334. [Abstract] [Full Text] [PDF]
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J. D. Newman, P. B. Bergman, J. C.G. Doery, and N. D.H. Balazs Factitious increase in thyrotropin in a neonate caused by a maternally transmitted interfering substance. Clin. Chem., March 1, 2006; 52(3): 541 - 542. [Full Text] [PDF]
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 J.-P. Quenot, G. Le Teuff, C. Quantin, J.-M. Doise, M. Abrahamowicz, D. Masson, and B. Blettery Myocardial Injury in Critically Ill Patients: Relation to Increased Cardiac Troponin I and Hospital Mortality Chest, October 1, 2005; 128(4): 2758 - 2764. [Abstract] [Full Text] [PDF]
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C. Roongsritong, I. Warraich, and C. Bradley Common Causes of Troponin Elevations in the Absence of Acute Myocardial Infarction: Incidence and Clinical Significance Chest, May 1, 2004; 125(5): 1877 - 1884. [Abstract] [Full Text] [PDF]
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 C. M. Preissner, D. J. O'Kane, R. J. Singh, J. C. Morris, and S. K. G. Grebe Phantoms in the Assay Tube: Heterophile Antibody Interferences in Serum Thyroglobulin Assays J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3069 - 3074. [Abstract] [Full Text] [PDF]
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M. Panteghini and F. Pagani On the Comparison of Serum and Plasma Samples in Troponin Assays Clin. Chem., May 1, 2003; 49(5): 835 - 836. [Full Text]
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R. M. Dorizzi, M. Caputo, A. Ferrari, L. Lippa, and P. Rizzotti Comparison of Serum and Heparin-Plasma Samples in Different Generations of Dimension Troponin I Assay Clin. Chem., December 1, 2002; 48(12): 2294 - 2296. [Full Text] [PDF]
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