The Role of High Sensitivity Troponin: More Acute Coronary Syndromes or More False Positive Results?

Abstract

Cardiac troponins (cTn) are the most sensitive and specific biomarkers of myocardial damage. Troponin has both diagnostic and prognostic significance for acute coronary syndrome (ACS). The joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation task force recommendations for a universal definition of acute myocardial infarction (AMI) in 2007 are based on detection of cTn and associated clinical evidence. Although the clinical introduction of new generation high sensitivity cTnT and cTnI assays is certainly valuable in the appropriate setting, its widespread use in a variety of clinical situations may lead to the detection of cTn elevation in absence of thrombotic ACS. Until now there is no clarity between “sensitive†and “high sensitive†cTn assays something that raises concerns regarding the interpretation of the latest clinical studies. The increased analytical sensitivity against compromised specifity may increase ‘‘false positive’’ results in patients with cardiovascular disease or apparently healthy subjects with previously undetected cTn levels. A cTn rise in the absence of ACS should prompt for an assessment for a different, non-ischemic mechanism of troponin elevation and direct management at the primary cause. The role of the clinician is to apply clinical doubts where abnormal cTn levels are not due to myocardial injury. The current strategy of management of such patients is based on established algorithms and clinical knowledge.