DOI: https://doi.org/10.22141/2224-0586.16.1.2020.196938

Troponins. Clinical significance and interpretation of laboratory test results

О.V. Bilchenko

Abstract


The use of troponins in clinical practice has led to a breakthrough in the diagnosis of myocardial infarction (MI), ho­wever, to date, there remains a large number of erroneous diagnoses due to an incorrect assessment of the results of troponin tests. Cardiac troponin (cTn) is a complex consisting of three subunits. Since cardiac troponins I (cTnI) and T (cTnT) are components of the contractile apparatus of myocardial cells and are expressed almost exclusively in the heart, this determines their high specificity as a biomarker of myocardial damage. Assessment of the release of a pool of rapidly released troponins into the bloodstream in clinical practice, on the one hand, can reduce the time for the diagnosis of myocardial infarction, and on the other hand, will lead to a significant decrease in the specificity of the determination of troponins with respect to structural damage and myocardial necrosis. The release of troponins occurs with various variants of myocardial damage, and not just due to necrosis. An increase in the level of troponins in blood plasma indicates the presence of myocardial damage, but does not indicate the cause and mechanism of the damage. The diagnosis of myocardial infarction is confirmed by detecting a dynamic increase in the level of troponins above the re­ference value only if there is evidence that the cause of myocardial damage is its irreversible ischemia. A key distinguishing feature of highly sensitive troponin tests compared to previous analyzes is the increased sensitivity, which is manifested only at values close to the 99th percentile of the upper reference level. From the 1st to 4th ge­neration of troponin tests, only significant amounts of troponin can be determined due to massive myocardial damage. The amounts of troponin corresponding to the release of cytosolic troponin or due to micro-necrosis of cardiomyocytes can be determined by the 5th generation of troponin tests. The key advantage of the 5th generation of troponin tests is not an increase in the accuracy of diagnosis of myocardial infarction, but a reduction in the time until the diagnosis is verified using the troponin test. An algorithm that combines an assessment of both the absolute level and the relative change in the level of troponins allows increasing the specificity (with a slight decrease in sensitivity) in relation to the diagnosis of myocardial infarction. The results of highly sensitive troponin tests can be widely used to evaluate prognosis.

Keywords


biomarkers; troponin test; myocardial infarction; diagnostic algorithm; prognosis

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