High-sensitivity cardiac troponins: no more ‘negatives’

Abstract

According to recently published expert guidelines, cardiac troponins are the only accepted biomarkers to define acute myocardial infarction. New high sensitivity cardiac troponin assays provide exciting opportunities for early rule-out and rule-in strategies and for identifying high-risk patients early in their presentation to guide early treatment and intervention. This review briefly discusses the history of troponin testing, before going on to cover clinical uses of the new highly sensitive assays in the early assessment of acute myocardial infection. Common clinical pitfalls with the use of these assays are discussed, as is the use of highly sensitive troponins more widely as prognostic markers. Likely future developments in this area are discussed.

Keywords::

• acute myocardial infarction
• cardiac diagnostic techniques
• cardiovascular
• chest pain
• high-sensitivity cardiac troponins
• troponin assays troponin

Financial & competing interests disclosure

K Greaves has received funding from AstraZeneca for Acute Coronary Syndromes research. The authors have no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Myocardial infarction (MI) is diagnosed with and defined by cardiac troponin levels as per the recent third Universal Definition of MI.

• • New high sensitivity cardiac troponin assays are now available and in use in many hospitals in Europe, but are not yet available in the USA.

• • These assays are extremely sensitive at ruling-out acute MI earlier after pain and are now recommended in European Society of Cardiology guidelines.

• • High-sensitivity assays have the potential to accelerate very significantly the assessment of patients with chest pain.

• • The reduced specificity of high sensitivity cardiac troponin assays has caused concern among clinicians, but serial sampling can be used to improve this, although there remains no consensus in the literature as to when sampling should occur and how to interpret serial changes.

• • The main pitfalls in clinical use relate to the reduced specificity, which requires careful clinical assessment to integrate troponin results.

• • High-sensitivity troponin levels are prognostic in a variety of acute and chronic situations.

• • Further research will be needed to fully define the clinical use of high sensitivity cardiac troponin assays.

Notes

Data taken from [11].