High-sensitivity troponin assays: development and utility in a modern health-care system

ABSTRACT

Introduction: The introduction of cardiac troponin (cTn) assays have revolutionized the diagnosis and management of acute myocardial infarction in Emergency Departments worldwide. Its success has led to significant research and development investment in this area culminating in the development of newer high-sensitivity cardiac troponin assays (hs-cTn). While these newer assays allow for more rapid diagnosis by decreasing the time interval between serial data points, there is an inevitable trade off between increasing sensitivity and specificity. This review examines in detail the introduction and implementation of hs-cTN and its implications for clinical practice.

Areas covered: This article reviews the history and development of high-sensitivity troponin assays and their application to clinical practice and current evidence base. It also discusses both the positive and negative aspects of the continuing increasing sensitivity of biochemical assays and the translation of this into clinical practice. Potential future developments are also discussed.

Expert commentary: It is clear that there are many benefits to detecting extremely low concentration of cardiac troponin including the development of rapid rule out algorithms and the cost and time-saving advantages associated with the quicker movement of patients through the health-care system. It is important to note however that detecting troponin at very low concentrations also dramatically increases the false-positive rates and leads to a potentially large increase in invasive testing and diagnosis of myocardial infarction.

KEYWORDS:

• High-sensitivity cardiac troponin
• acute myocardial infarction
• ischemic heart disease

Article Highlights

• High-sensitivity cardiac troponin (hs-cTN) is able to detect the release of cardiac troponin at very low levels and very early post myocardial injury.

• The development of hs-cTN allows rapid identification of patients with evidence of myocardial injury.

• As hs-cTN is detectable at very low concentrations, care must be taken to apply good clinical judgment to avoid over investigation of patient inappropriately as hs-cTN is elevated in many other cardiac and noncardiac pathologies.

• Further research is needed to inform on the significance of troponin elevation outside of acute plaque rupture, and helo decide on the best management strategy for these patients.

• Novel biomarkers such as micro RNA have potential to add to diagnostic information provided by hs-cTN.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.