Challenges in high-sensitive troponin assay interpretation for intensive therapy

Abstract

Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.

Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

“…Transesophageal echocardiography cardiac function monitoring and pro-brain natriuretic peptide may also be used as indicators of myocardial function in response surgery ( 30 ). However, cTnI is a highly sensitive and specific biomarker in the diagnosis of myocardial injury in the clinic ( 31 ). In addition, Dex inhibits the release of catecholamines to reduce HR ( 32 ), which prolongs coronary perfusion and simultaneously reduces myocardial oxygen consumption, thus improving the maintenance of the myocardial oxygen supply-demand balance ( 33 , 34 ).…”

Clinical efficacy of atorvastatin calcium combined with aspirin in patients with acute ischemic stroke and effect on neutrophils, lymphocytes and IL-33

“…The specific pathogenesis of AIS is not clear, but inflammation and thrombosis are currently considered to be the key factors in the pathogenesis of ischemic stroke ( 17 , 26 , 27 ). Platelet activation and coagulation thrombosis play an important role in the pathological and physiological process of recurrent ischemic vascular events in stroke patients ( 28 ).…”

“…This result is also similar to the results of Galun et al (25), finding that stroke patients with smaller cerebral infarction had higher serum IL-33, and mild stroke patients had higher serum IL-33 than severe stroke patients. The specific pathogenesis of AIS is not clear, but inflammation and thrombosis are currently considered to be the key factors in the pathogenesis of ischemic stroke (17,26,27). Platelet activation and coagulation thrombosis play an important role in the pathological and physiological process of recurrent ischemic vascular events in stroke patients (28).…”

Extremely high troponin levels induced by septic shock: a case report

“…Troponin level is elevated in various diseases other than acute myocardial infarction (AMI), including sepsis. In these diseases, the elevated troponin level is relatively low; the higher the troponin, the greater the possibility of AMI [ 1 ]. Moreover, in AMI, the elevated troponin level persists for 7–10 days owing to necrotic release from cardiomyocytes, but in other diseases, the troponin level declines relatively rapidly [ 1 ].…”

“…In these diseases, the elevated troponin level is relatively low; the higher the troponin, the greater the possibility of AMI [ 1 ]. Moreover, in AMI, the elevated troponin level persists for 7–10 days owing to necrotic release from cardiomyocytes, but in other diseases, the troponin level declines relatively rapidly [ 1 ]. A report showed that patients with sepsis who had higher troponin levels tended to have a higher mortality rate [ 2 ].…”