High sensitivity troponins and conventional troponins at the bedside

Abstract

The continuing advances in the biochemical research for the discovering an ideal biomarker for diagnosing myocardial injury have led to discovery cardiac Troponin, a biochemical gold standard for myocardial necrosis. Further with advances in the immunoassay techniques, the 99th percentile cutoff value of cardiac troponin required for the diagnosis of myocardial infarction decreased, with the latest available ultrasensitive cardiac troponin assay capable of measuring level as low as 0.005 ng/ml. Troponin have both diagnostic as well as prognostic significance in myocardial necrosis, but the cut off value by 99th percentile rule is useful only when applied to patients with a high pretest probability of Acute Coronary Syndrome(ACS) and also the results must be interpreted in the context of clinical history, ECG findings, and possibly cardiac imaging to establish the correct diagnosis. As cardiac troponins are also elevated in other cardiac conditions such as cardiomyopaties, the serial monitoring of the cardiac troponin level along with the absolute value would help to differentiate myocardial infarction from these many varied conditions, with the interval of serial assay being reduced to 3 hours. The aim of this review is to complement the advantages, to emphasize on proper interpretation of positive results, to appraise the challenges faced with the available cardiac troponin assays and need for further research to overcome them and build up the most ideal cardiac marker for diagnosing the myocardial infarction.

Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India

“…This is commonly referred as the ‘99th percentile rule’. This level must be determined for each assay with a good quality control in every centre 35, 54, 55, 56…”

Early Serum Biomarkers for Intensive Care Unit Treatment within the First 24 Hours in Patients with Intracerebral Hemorrhage

“…12 Elevated troponin I (TNI), as a sensitive serum biomarker for cardiac complications and secondary pulmonary complications after central nervous system insults, could be found in $20% of ICH patients; even the pathophysiologic pathway is still unclear. 6,9,13,14 Left ventricular apical systolic akinesia, resembling takotsubo cardiomyopathy, and myocardial stunning are typical reversible cardiac problems after subarachnoid hemorrhage, even in the absence of coronary stenosis. 2 These cardiac events may be induced by excessive release of catecholamines into the systemic circulation and has been well investigated in patients with subarachnoid hemorrhage.…”

The Diagnostic Value of Ultra-Troponin I in Patients Admitted to Emergency Department with Chest Pain and Performed Coronary Angiography

“…Miyokardial nekroza bağlı hasarı gösteren TnI yüksekliği altta yatan mekanizmayı değil de hasarın varlığını gösterir bu nedenle TnI'nin iskemik olmayan yükselme nedenleri de akılda tutulmalıdır (12,13) .…”