Accepted Manuscript Macrotroponin Causing Elevation in Cardiac Troponin I Sophia L. Wong, MD Saul Isserow, MB BCh, FRCPC, FACC Morris Pudek, PhD, FACB PII:
S0828-282X(14)00223-2
DOI:
10.1016/j.cjca.2014.03.037
Reference:
CJCA 1169
To appear in:
Canadian Journal of Cardiology
Received Date: 17 February 2014 Revised Date:
25 March 2014
Accepted Date: 25 March 2014
Please cite this article as: Wong SL, Isserow S, Pudek M, Macrotroponin Causing Elevation in Cardiac Troponin I, Canadian Journal of Cardiology (2014), doi: 10.1016/j.cjca.2014.03.037. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Wong et al.
RI PT
Macrotroponin Causing Elevation in Cardiac Troponin I
SC
Sophia L. Wong, MD, Saul Isserow, MB BCh, FRCPC, FACC, and Morris Pudek, PhD, FACB
Vancouver General Hospital/University of British Columbia,
M AN U
Vancouver, British Columbia, Canada
Corresponding Author:
TE D
Dr. Sophia L. Wong
UBC Department of Pathology & Laboratory Medicine
EP
855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada Phone: (604) 723-3407
AC C
E-mail: [email protected]
Manuscript Received: February 17th, 2014 Manuscript Revised: March 24th, 2014 List of Support/Grant Information: N/A
Page 1
ACCEPTED MANUSCRIPT Wong et al. Brief Summary/Abstract We report a case of macrotroponin causing persistently raised cardiac troponin I (cTnI) results in a 57-year-old male with recurrent atypical chest pain. Macrotroponin – a troponin-
RI PT
immunoglobulin complex – should be considered when cTnI values are inconsistent with the clinical picture, and fail to demonstrate a rise and/or fall pattern in suspected cases of acute
AC C
EP
TE D
M AN U
is essential in the management of macrotroponin patients.
SC
coronary syndrome. Clear and effective communication between cardiologists and laboratorians
Page 2
ACCEPTED MANUSCRIPT Wong et al. Case Presentation A 57-year-old male presented with recurrent atypical chest pain, and non-specific ST changes and left axis deviation on electrocardiogram (ECG). Past medical history was significant for
RI PT
hypertension, dyslipidemia, coronary vasospasm, and coronary artery disease (CAD), with insertion of a bare metal stent to the proximal left anterior descending (LAD) artery for a 50% lesion (fractional flow reserve 0.79) four months prior. Serial cardiac troponin I (cTnI) measured
SC
on the Siemens Dimension Vista platform (99th percentile,
S0828-282X(14)00223-2
DOI:
10.1016/j.cjca.2014.03.037
Reference:
CJCA 1169
To appear in:
Canadian Journal of Cardiology
Received Date: 17 February 2014 Revised Date:
25 March 2014
Accepted Date: 25 March 2014
Please cite this article as: Wong SL, Isserow S, Pudek M, Macrotroponin Causing Elevation in Cardiac Troponin I, Canadian Journal of Cardiology (2014), doi: 10.1016/j.cjca.2014.03.037. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Wong et al.
RI PT
Macrotroponin Causing Elevation in Cardiac Troponin I
SC
Sophia L. Wong, MD, Saul Isserow, MB BCh, FRCPC, FACC, and Morris Pudek, PhD, FACB
Vancouver General Hospital/University of British Columbia,
M AN U
Vancouver, British Columbia, Canada
Corresponding Author:
TE D
Dr. Sophia L. Wong
UBC Department of Pathology & Laboratory Medicine
EP
855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada Phone: (604) 723-3407
AC C
E-mail: [email protected]
Manuscript Received: February 17th, 2014 Manuscript Revised: March 24th, 2014 List of Support/Grant Information: N/A
Page 1
ACCEPTED MANUSCRIPT Wong et al. Brief Summary/Abstract We report a case of macrotroponin causing persistently raised cardiac troponin I (cTnI) results in a 57-year-old male with recurrent atypical chest pain. Macrotroponin – a troponin-
RI PT
immunoglobulin complex – should be considered when cTnI values are inconsistent with the clinical picture, and fail to demonstrate a rise and/or fall pattern in suspected cases of acute
AC C
EP
TE D
M AN U
is essential in the management of macrotroponin patients.
SC
coronary syndrome. Clear and effective communication between cardiologists and laboratorians
Page 2
ACCEPTED MANUSCRIPT Wong et al. Case Presentation A 57-year-old male presented with recurrent atypical chest pain, and non-specific ST changes and left axis deviation on electrocardiogram (ECG). Past medical history was significant for
RI PT
hypertension, dyslipidemia, coronary vasospasm, and coronary artery disease (CAD), with insertion of a bare metal stent to the proximal left anterior descending (LAD) artery for a 50% lesion (fractional flow reserve 0.79) four months prior. Serial cardiac troponin I (cTnI) measured
SC
on the Siemens Dimension Vista platform (99th percentile,
