False Elevation of Troponin in a Case of Multiple Myeloma

Abstract

Falsely elevated troponin has been reported in the literature. The authors present a case of a 51-year-old man who was admitted with nausea, vomiting, and chest discomfort. He was found to have elevated troponin with no electrocardiographic changes. He has normal coronaries on angiogram and normal echocardiogram. A diagnostic time-out and second look at the laboratory values captured abnormalities that triggered a workup that ruled in a multiple myeloma diagnosis. We suspected falsely elevated troponin levels secondary to macrotroponin, a complex of elevated immunoglobulin levels and troponin, which has been rarely reported to cause elevated troponin levels in patients with multiple myeloma.

Changes of myocardial dysfunction and injury biomarkers over chemotherapy for multiple myeloma: difficulties in laboratory data interpretation

“…Последний является комплексом из парапротеина и тропонина I или T; встречается не только у пациентов с ММ, но также после вакцинации против COVID-19 или непосредственно перенесенной инфекции SARS-CoV-2. С целью снижения рисков получения ложноположительных результатов уровня сердечных тропонинов, авторы приведенных исследований рекомендуют добавление полиэтиленгликоля к сыворотке пациента, что позволяет связать иммуноглобулин и высвободить молекулы тропонина для более точной интерпретации [25][26][27].…”

Role of Antitroponin Antibodies and Macrotroponin in the Clinical Interpretation of Cardiac Troponin

“…When patients with these conditions experience a modest increase in cTn levels following valve surgery, acute heart failure, or cardiac interventions, the concurrent presence of interfering antibodies may lead to disproportionate elevations if the assay is susceptible to interference (Figure S9 ). Finally, recent exploratory data and reports suggest that macrotroponin may explain some of the early hs‐cTn elevations in patients with normal left ventricular function receiving treatment for breast cancer or in patients with hematologic cancer 73 , 74 and should therefore be a consideration in the field of cardio‐oncology. Consequently, it is crucial to incorporate the clinical context, consistently reevaluate the cTn results, and interpret them accordingly (Figure 6 ).…”