Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

Abstract

BACKGROUND Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. In this review, we have summarized the data from studies investigating the implications of cardiac troponin concentrations in various acute and chronic conditions beyond ACS, i.e., heart failure, myocarditis, Takotsubo cardiomyopathy, aortic dissection, supraventricular arrhythmias, valve disease, pulmonary arterial hypertension, stroke, and in the perioperative setting. CONTENT Cardiac troponin concentrations are often detectable and frankly increased in non-ACS conditions, in particular when measured with high-sensitivity (hs) assays. With the exception of myocarditis and Takotsubo cardiomyopathy, cardiac troponin concentrations carry strong prognostic information, mainly with respect to mortality, or incipient and/or worsening heart failure. Studies investigating the prognostic benefit associated with cardiac troponin–guided treatments however, are almost lacking and the potential role of cardiac troponin in the management of non-ACS conditions is not defined. SUMMARY Increased cardiac troponin indicates increased risk for adverse outcome in patients with various cardiovascular conditions beyond ACS. Routine measurement of cardiac troponin concentrations can however, not be generally recommended unless there is a suspicion of ACS. Nonetheless, any finding of an increased cardiac troponin concentration in a patient without ACS should at least prompt the search for possible underlying conditions and these should be managed meticulously according to current guidelines to improve outcome.

Cocaine use is associated with a higher prevalence of elevated ST2 concentrations

“…Although cTn is commonly increased in HF, routine cTn measurements are currently not recommended unless there is suspicion of underlying acute coronary syndrome (ACS) [14]. Therefore, and as ST2 concentrations are not increased in ACS [15], a multimarker approach including ST2 may overcome limitations related to cTn as single biomarker for risk-stratification, i.e.…”

Anti-cardiac troponin antibodies in clinical human disease: a systematic review

“…In a recent study in the setting of ST-elevation acute MI, beta-1 adrenoceptor autoantibodies were associated with adverse outcomes (being an independent predictor of major adverse cardiovascular events) (39). Evermore sensitive assays for cardiac troponins have demonstrated that these biomarkers may be detectable in several clinical conditions, as well as in a significant proportion of healthy subjects (59,60). Anticardiac troponin autoantibodies have also been described in different settings (namely in healthy subjects and after MI) (6).…”

Decreased admissions and hospital costs with a neutral effect on mortality following lowering of the troponin T cutoff point to the 99th percentile

“…This may have resulted in sampling bias, with the selection of younger patients with fewer comorbidities. The new medical protocol that was implemented when hs-cTnT cutoff was lowered to the 99th percentile stated that the only indication of a hs-cTnT test is suspicion of acute cardiac damage [22] and alerted the attending physician to the fact that old age [6,15], decreased kidney function [23][24][25] and heart failure [26,27] can result in false positive hs-cTnT results. This could be an explanation behind decreased hs-cTnT sampling frequency Recorded heart diagnosis except for hypertension among patients that were not analyzed with hs-cTnT during the ED visit or hospital stay.…”