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. 2023 Aug 1;34(5):351-355.
doi: 10.1097/MCA.0000000000001257. Epub 2023 Jun 5.

Development of saliva-based cardiac troponin I point-of-care test using alpha-amylase depletion: a feasibility study

Roi Westreich  1 , Gal Tsaban  1 , Yoav Neumann  2 , Amjad Abu Salman  1 , Omri Braver  1 , Dana Braiman  1 , Tali Zamed  1 , Zipora Feiga Neuhaus  1 , Omer Deutsch  2 , Aaron Palmon  2 , Nimrod Maimon  1 , Doron Zahger  1 , Yigal Abramowitz  1
Affiliations

Development of saliva-based cardiac troponin I point-of-care test using alpha-amylase depletion: a feasibility study

Roi Westreich et al. Coron Artery Dis. .

Abstract

Introduction: Cardiac troponin (cTn) is the biomarker of choice for detection of myocardial injury. There is a great need for simple point-of-care (POC) troponin testing among patients with chest pain, mainly in the prehospital setting. The purpose of this study was to evaluate the presence of cardiac troponin I (cTnI) in saliva of patients with myocardial injury using alpha-amylase depletion technique.

Methods: Saliva samples were collected from 40 patients with myocardial injury who were tested positive for conventional high-sensitivity cardiac troponin T (cTnT) blood tests, and from 66 healthy volunteers. Saliva samples were treated for the removal of salivary alpha-amylase. Treated and untreated samples were tested with blood cTnI Rapid Diagnostic Test. Salivary cTnI levels were compared to blood cTnT levels.

Results: Thirty-six of 40 patients with positive blood cTnT had positive salivary samples for cTnI following alpha-amylase depletion treatment (90.00% sensitivity). Moreover, three of the four negative saliva samples were obtained from patients with relatively low blood cTnT levels of 100 ng/L or less (96.88% sensitivity for 100 ng/L and above). The negative predictive value was 93.65% and rose up to 98.33% considering the 100 ng/L cutoff. Positive predictive values were 83.72% and 81.58%, respectively. Among 66 healthy volunteers and 7 samples yielded positive results (89.39% specificity).

Conclusion: In this preliminary work, the presence of cTnI in saliva was demonstrated for the first time to be feasibly identified by a POC oriented assay. The specific salivary alpha-amylase depletion technique was shown to be crucial for the suggested assay.

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