Troponins. Clinical significance and interpretation of laboratory test results

О.V. Bilchenko


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.


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


Ebashi S., Kodama A. A new protein factor promoting aggregation of tropomyosin. J. Biochem. 1965 Jul. 58(1). 107-8.

Katus H.A., Remppis A., Looser S., Hallermeier K., Scheffold T., Kübler W. Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. J. Mol. Cell Cardiol. 1989 Dec. 21(12). 1349-53.

World Health Organization Expert Committee. Hypertension and coronary heart disease: classification and criteria for epidemiological studies. First report of the expert committee on cardiovascular diseases and hypertension. WHO Tech. Rep. Ser. 1959. 168.

Garg P., Morris P., Fazlanie A.L., Vijayan S., Dancso B., Dastidar A.G., Plein S., Mueller C., Haaf P. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Intern. Emerg. Med. 2017 Mar. 12(2). 147-155. doi: 10.1007/s11739-017-1612-1.

Thygesen K., Mair J., Giannitsis E., Mueller C., Lindahl B., Blankenberg S., Huber K., Plebani M., Biasucci L.M., Tubaro M., Collinson P., Venge P., Hasin Y., Galvani M., Koenig W., Hamm C., Alpert J.S., Katus H., Jaffe A.S.; Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur. Heart J. 2012. 33. 2252-2257.

White H.D. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J. Am. Coll Cardiol. 2011 Jun 14. 57(24). 2406-8.

Kristian Thygesen, Joseph S. Alpert, Allan S. Jaffe, Bernard R. Chaitman, Jeroen J. Bax, David A. Morrow, Harvey D. White: the Executive Group on behalf of the Joint European Society of Cardio­logy (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction Fourth universal definition of myocardial infarction (2018) European Heart Journal. 2018. 00. 1-33.

Røysland R., Kravdal G., Høiseth A.D., Nygård S., Badr P., Hagve T.A., Omland T., Røsjø H. Cardiac troponin T levels and exer­cise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study. Clin. Sci. (Lond.). 2012 Jun. 122(12). 599-606.

Balk E.M., Ioannidis J.P., Salem D., Chew P.W., Lau J. Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. Ann. Emerg. Med. 2001 May. 37(5). 478-94.

Collinson P.O., Saenger A.K., Apple F.S.; IFCC C-CB. High sensitivity, contemporary and point-of-care cardiac troponin assays: educational aids developed by the IFCC Committee on Clinical Application of Cardiac Bio-Markers. Clin. Chem. Lab. Med. 2019 Apr 24. 57(5). 623-632. doi: 10.1515/cclm-2018-1211.

Saenger A.K., Beyrau R., Braun S., Cooray R., Dolci A., Frei­dank H., Giannitsis E., Gustafson S., Handy B., Katus H., Melanson S.E., Panteghini M., Venge P., Zorn M., Jarolim P., Bruton D., Jarausch J., Jaffe A.S. Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin. Chim. Acta. 2011. 412. 748-754.

Ndrepepa G., Braun S., Mehilli J., Birkmeier K.A., Byr­ne R.A., Ott I., Hösl K., Schulz S., Fusaro M., Pache J., Hauslei­ter J., Laugwitz K.L., Massberg S., Seyfarth M., Schömig A., Kastrati A. Prognostic value of sensitive troponin T in patients with stable and unstable angina and undetectable conventional troponin. Am. Heart J. 2011. 161. 68-75.

Masson S., Anand I., Favero C., Barlera S., Vago T., Bertocchi F., Maggioni A.P., Tavazzi L., Tognoni G., Cohn J.N., Latini R.; Valsartan Heart Failure Trial (Val-HeFT) and Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza Cardiaca-Heart Failure (GISSI-HF) Investigators. Serial measurement of cardiac troponin T using a highly sensitive assay in patients with chronic heart failure: data from 2 large randomized clinical trials. Circulation. 2012 Jan 17. 125(2). 280-8. doi: 10.1161/CIRCULATION AHA.111.044149.

Roffi M., Patrono C., Collet J.P., Mueller C., Valgimigli M., Andreotti F., Bax J.J., Borger M.A., Brotons C., Chew D.P., Gencer B., Hasenfuss G., Kjeldsen K., Lancellotti P., Landmesser U., Mehilli J., Mukherjee D., Storey R.F., Windecker S.; ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2016 Jan 14. 37(3). 267-315. doi: 10.1093/eurheartj/ehv320.

Mueller M., Biener M., Vafaie M., Doerr S., Keller T., Blankenberg S., Katus H.A., Giannitsis E. Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin. Chem. 2012. 58. 209-218.

Shah A.S., Griffiths M., Lee K.K., McAllister D.A., Hun­ter A.L., Ferry A.V., Cruikshank A., Reid A., Stoddart M., Strachan F., Walker S., Collinson P.O., Apple F.S., Gray A.J., Fox K.A., Newby D.E., Mills N.L. BMJ. 2015 Jan 21. 350. 7873.

Rubini Giménez M., Twerenbold R., Boeddinghaus J., Nes­telberger T., Puelacher C., Hillinger P., Wildi K., Jaeger C., Grimm K., Heitzelmann K.F., Sabti Z., Badertscher P., Cupa J., Honegger U., Schaerli N., Kozhuharov N., du Fay de Lavallaz J., Lopez B., Salgado E., Miró Ò., Martín-Sánchez F.J., Adrada E.R., Morawiec B., Parenica J., Ganovska E., Neugebauer C., Rentsch K., Lohrmann J., Osswald S., Reichlin T., Mueller C. JAMA Cardiol. 2016 Nov 1. 1(8). 912-920.

Sörensen N.A., Ludwig S., Makarova N., Neumann J.T., Lehmacher J., Hartikainen T.S., Haller P.M., Keller T., Blankenberg S., Westermann D., Zeller T., Schofer N. Prognostic Value of a Novel and Established High-Sensitivity Troponin I Assay in Patients Presenting with Suspected Myocardial Infarction. Biomolecules. 2019 Sep 9. 9(9). E469. doi: 10.3390/biom9090469.

Sui Y., Liu T., Luo J., Xu B., Zheng L., Zhao W., Guan Q., Ren L., Dong C., Xiao Y., Qin X., Zhang Y. Elevation of high-sensitivity cardiac troponin T at admission is associated with increased 3-month mortality in acute ischemic stroke patients treated with thrombolysis. Clin. Cardiol. 2019 Oct. 42(10). 881-888. doi: 10.1002/clc.23237.

Copyright (c) 2020 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта