High sensitivity cardiac troponins: Can they help in diagnosing myocardial ischaemia?

Abstract

Circulating troponin increases in most patients undergoing a stress test, irrespective of the test result and of coronary artery disease. Plasma release of troponin depends on multiple pathogenetic mechanisms, making the biomarker a not reliable tool in detecting transient ischaemia.

Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina

“…The increase of troponins after exercise was reported in several previous studies that involved clinically stable patients and apparently healthy subjects but showed some discordant results. Some studies, indeed, reported a greater increase of troponins in ischemic, compared to non-ischemic, patients [5,8,11], but other studies failed to demonstrate a significant relation with both myocardial ischemia and presence of obstructive CAD [17,18]. Our study shows results that are in agreement with those of the latter reports, as no significant relation with both ischemic ECG changes and obstructive CAD could be found.…”

“…It is worth noting that the increase of hs-TnT in our patients was also largely independent of various clinical and EST variables, although, at univariable analysis, it was found greater in hypertensive patients and in patients who during EST achieved a maximal HR ≥85% of that predicted for age, while no significant changes were detected in diabetic patients. The greater hs-TnT increase after exercise in patients achieving higher HR and in hypertensive patients can be attributed to the high cardiac workload and a likely increased left ventricle mass [17], respectively. On the other hand, the lack of changes in hs-TnT after EST in diabetic patients does not have ready explanations; however, the diabetes subgroup included 10 patients only, and therefore further assessment is required to verify whether the different results observed in this subgroup, as compared to all others, was real or just an effect of chance.…”

Diagnostic accuracy of functional, imaging and biochemical tests for patients presenting with chest pain to the emergency department: A systematic review and meta-analysis

“…As previously reported and as confirmed by our analysis, rapid protocols report a very high sensitivity, which is non-inferior to six-hour protocols. Despite recent concerns relating to the risk of missing some diagnosis of ACS, 6 our results confirm, in line with the latest ESC guidelines for the management of NSTE-ACS, that ACS protocols have comparable sensitivity as compared to six-hour protocols and can therefore be safely used to rule-out ACS in the ED setting. 5 Copeptin is a recent adjunct to clinical practice, which has been reported to improve the diagnostic performance of troponin.…”

“…The 2015 European Society of Cardiology (ESC) guidelines for non-ST elevation ACS (NSTE-ACS) introduced and recommended the use of fast hs-TnT protocol (0-1 and 0-3 h hs-TnT assessment), but doubts still persist about the non-inferiority of this protocol as compared to the six-hour protocol. 5,6 Recently, copeptin has been proposed as an adjunct to troponin to improve diagnostic accuracy but data from its use in clinical practice are still limited. 7,8 The diagnostic assessment of chest pain becomes more intricate when patients report complaints suspect for ACS but negative troponin values.…”

Improving diagnosis, reperfusion therapy and secondary prevention in acute myocardial infarction

“…In a study from Pisa the majority of patients (72%) who underwent exercise testing or dobutamine stress echocardiography showed a significant increase of high sensitivity cardiac troponin T (hs-cTnT). 7 These increases were however not related to the presence or absence of inducible ischemia and were also observed in patients without obstructive coronary artery disease. Left ventricular hypertrophy was the strongest factor predicting a rise of hs-cTnT.…”