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The interpretation of cardiac troponin results has become challenging because of the availability of highly sensitive troponin assays able to detect even small cardiac damage. To investigate whether the highly sensitive cardiac troponin T assay (hs-cTnT) improves early AMI detection, a comparative evaluation between hs-cTnT and the 4th generation assay (4th-cTnT) was performed. Patients who presented to the Emergency Department from June to September 2011 with chest pain were recruited. Blood samples were taken at admission (T0), 1 (T1), 3, 6 and 12 h after presentation and were analysed by 4th-cTnT and hs-cTnT using Modular SWA E170 analyzer (Roche Diagnostics). For this study, only samples at T0 and T1 were evaluated. Of the 386 patients recruited, 32 (8.3%) had AMI. The sensitivity of hs-cTnT at T0 was 72% vs. 50% of 4th-cTnT. In T1 samples the sensitivity of hs-cTnT (97%) was slightly higher than 4th-cTnT (78%) (P=0.06). Our preliminary results showed that hs-cTnT can detect AMI 1 h after the hospital arrival in the majority of patients. Ongoing studies will define best algorithms for the effective use of hs-cTnT results in clinical practice. Rule-out and rule-in algorithms will have to be fine tuned to exploit cost-savings associated with this early diagnostic accuracy.

An important prognostic factor in patients with chronic lymphocytic leukemia (CLL) is the mutational status of immunoglobulin heavy chain variable region genes (IgVH), whose determination depends on the comparison between the nucleotide sequence of IgVH expressed by the leukemic clone of the patient and the germ line of the concerned family. If the calculated homology is >98%, the patient is deemed unmutated and the clinical course is unfavorable. Two reference database custodians of nucleotide sequences of the germ line [GenBank/IgBlast and Immunogenetics Information System (IMGT)] are the most accessed for the comparison. The aim of this work was to evaluate what database provides a more accurate assessment of the IgVH mutational status. The latter was examined by automated sequencing in patients with CLL (n = 204) and the percentage of homology was assessed by both databases. The analysis revealed that in six patients the two databases assigned a different family, because some alleles or families are present only in IgVH dataset of IMGT. When IgVH family was the same in both databases, the percentage of homology showed a difference in 50% of the subjects. Depending on the database used for comparison, six subjects, with homology close to 98%, have a different mutational status with associated different prognosis estimate. In conclusion, the IMGT database is more comprehensive and updated allowing to define the percentage of homology, and therefore the prognostic value, more accurately.