High sensitivity troponins in contemporary cardiology practice: are we turning a corner?

Troponin has been the cornerstone of the definition of MI since its introduction to clinical practice. High-sensitivity troponin has allowed clinicians to detect degrees of myocardial damage at orders of magnitude smaller than previously and is challenging the definitions of MI, with implications for patient management and prognosis. Detection and diagnosis are no doubt enhanced by the greater sensitivity afforded by these markers, but perhaps at the expense of specificity and clarity. This review focuses on the definitions, pathophysiology, prognosis, prevention and management of type 2 MI and myocardial injury. The five types of MI were first defined in 2007 and were recently updated in 2018 in the fourth universal definition of MI. The authors explore how this pathophysiological classification is used in clinical practice, and discuss some of the unanswered questions in this era of availability of high-sensitivity troponin.

show abstract

“…However, only 6.1% had a final diagnosis of type 1 MI, suggesting that up to 17.9% may have had a type 2 MI or acute myocardial injury. [ 38 ]…”

Section: Current Definitionsmentioning

confidence: 99%

Type 2 MI and Myocardial Injury in the Era of High-sensitivity Troponin

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The variety of conditions that can be associated with an elevated cTn is listed in Table 2 (adapted from literature 1,8,12 ). It is clear from this list that many intensive care patients have multiple possible reasons to have an elevated cTn level.…”

Section: Type Of MI and The Causes Of Ctn Elevationmentioning

confidence: 99%

“…The commonly employed clinical algorithm that an elevated cTn, or even a rise in the cTn level, indicates a T1MI by default is clearly flawed: both T1 and T2 MIs are characterised in this way. 8,12 In routine circumstances, cTns should therefore be interpreted in the light of the clinical history and, specifically, an absence of a history of cardiac-sounding chest pain automatically makes the diagnosis of T1MI questionable in most clinical circumstances. 8,12,16 This makes interpretation in sedated and ventilated patients particularly challenging.…”

Section: Type Of MI and The Causes Of Ctn Elevationmentioning

confidence: 99%

“…8,12 In routine circumstances, cTns should therefore be interpreted in the light of the clinical history and, specifically, an absence of a history of cardiac-sounding chest pain automatically makes the diagnosis of T1MI questionable in most clinical circumstances. 8,12,16 This makes interpretation in sedated and ventilated patients particularly challenging. As a result it is easy to miss MI in ICU, as demonstrated by the increased MI diagnoses during intensive ECG and cTn screening.…”

Section: Type Of MI and The Causes Of Ctn Elevationmentioning

confidence: 99%

“…19 It is important, however, that the significance of an elevated cTn level in a patient is understood, even when T1MI has been excluded, because there are consistent data across the literature that demonstrate, probably irrespective of the underlying cause, that this is a biomarker associated with a worse clinical outcome. 8,10,12,16 cTn in general intensive care…”

Section: Type Of MI and The Causes Of Ctn Elevationmentioning

confidence: 99%

See 2 more Smart Citations

High sensitivity troponin measurement in critical care: Flattering to deceive or ‘never means nothing’?

Hinton

Mariathas

Grocott

et al. 2019

Journal of the Intensive Care Society

Self Cite

View full text Add to dashboard Cite

Introduction Troponin elevation is central to the diagnosis of acute type 1 myocardial infarction. It is, however, elevated in a range of other conditions, including type 2 myocardial infarction, and this setting is increasingly associated with adverse clinical outcomes. Patients within intensive care frequently have at least one organ failure together with a range of co-morbidities. Interpretation of troponin assay results in this population is challenging. This clinical uncertainty is compounded by the introduction of ever more sensitive troponin assays. Areas covered The aims of this review are to (a) describe the currently available literature about the use of troponin assays in intensive care, (b) analyse the challenges presented by the introduction of increasingly sensitive troponin assays and (c) assess whether the role of troponin assays in intensive care may change in the future, dependent upon recent and ongoing research suggesting that they are predictive of outcome regardless of the underlying cause: the ‘never means nothing’ hypothesis.

show abstract