A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part II: Non Cardiac Causes

Akwe, Joyce; Halford, Brittne; Kim, Erin; Miller, Amy

doi:10.15406/jccr.2018.11.00364

Cited by 10 publications

(6 citation statements)

References 74 publications

(126 reference statements)

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“…Rarely, non-cardiac conditions that result in myocardial injury without myocardial ischemia may result in troponin elevation [3]. These conditions include pulmonary embolism, end-stage renal disease, sepsis, stroke, and critically ill patients [6]. In these conditions, cTn has been reported to predict mortality, and elevated levels have been associated with a worse prognosis [3,7,8].…”

Section: Discussionmentioning

confidence: 99%

A Case of Type II Achalasia Presenting With Markedly Elevated Troponins

Malik¹,

Khan²,

Shah³

et al. 2023

Cureus

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Achalasia is an esophageal motility disorder that presents with dysphagia to solids and liquids and regurgitation of undigested food. Cardiac troponin (cTn) is a sensitive biomarker for myocardial injury, and elevated levels suggest an increased risk of mortality from acute coronary syndrome (ACS). Non-cardiac gastrointestinal (GI) causes of troponin elevation are rare and have generally been described in cases of critical illness (e.g., significant gastrointestinal bleeding (GIB) or acute liver failure). We report a rare case of type II achalasia presenting with markedly elevated troponins. This case illustrates an important GI-related mimic of ACS that should be considered by frontline providers and gastroenterologists.

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Section: Discussionmentioning

confidence: 99%

A Case of Type II Achalasia Presenting With Markedly Elevated Troponins

Malik¹,

Khan²,

Shah³

et al. 2023

Cureus

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“…Compared with conventional Tn assays, hs-Tn assays carry a two-fold increase in the detection of type 2 MI [50]. Additionally, as highlighted in the accompanying companion review [1], many conditions other than ACS can present with elevations in serum Tn, including cardiac conditions such as tachyarrhythmia and noncardiac conditions such as pulmonary (e.g., pulmonary embolism), renal (end-stage renal disease), neurologic (e.g., stroke), musculoskeletal (e.g., rhabdomyolysis), oncologic (e.g., when undergoing certain chemotherapies), and GI causes, as well as trauma (e.g., blunt chest trauma) and acute illness (e.g., sepsis) [70][71][72][73]. The etiology of the elevation can affect treatment.…”

Section: Clinical Implications Of High-sensitivity Troponinmentioning

confidence: 99%

Clinical Biochemistry of Serum Troponin

Gokhan,

Dong,

Grubman

et al. 2024

Diagnostics

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Accurate measurement and interpretation of serum levels of troponin (Tn) is a central part of the clinical workup of a patient presenting with chest pain suspicious for acute coronary syndrome (ACS). Knowledge of the molecular characteristics of the troponin complex and test characteristics of troponin measurement assays allows for a deeper understanding of causes of false positive and false negative test results in myocardial injury. In this review, we discuss the molecular structure and functions of the constituent proteins of the troponin complex (TnT, TnC, and TnI); review the different isoforms of Tn and where they are from; survey the evolution of clinical Tn assays, ranging from first-generation to high-sensitivity (hs); provide a primer on statistical interpretation of assay results based on different clinical settings; and discuss potential causes of false results. We also summarize the advances in technologies that may lead to the development of future Tn assays, including the development of point of care assays and wearable Tn sensors for real-time continuous measurement.

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“…Although Tn is commonly elevated in ACS and cardiac disorders, it can also be elevated due to non-cardiac etiologies, including pulmonary, renal, neurologic, musculoskeletal, oncologic, and gastrointestinal causes, as well as acute illness and trauma ( Figure 4 ). The pathophysiology of elevated Tn due to non-cardiac causes is not completely clear in some cases, but elevated Tn correlates closely with a poor prognosis in most of these conditions, which should be considered in the differential diagnosis of patients with elevated Tn and no clear cardiac cause [ 155 ]. The possibility of ACS should be considered alongside non-ACS causes of myocardial injury in each of the conditions below, using clinical judgment based on findings from the history, physical exam, ECG, and imaging data, such as an echocardiogram.…”

Section: Non-cardiovascular Etiologies Of Troponin Elevationmentioning

confidence: 99%

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

Maayah,

Grubman,

Allen

et al. 2024

Diagnostics

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Cardiac troponin (Tn) plays a central role in the evaluation of patients with angina presenting with acute coronary syndrome. The advent of high-sensitivity assays has improved the analytic sensitivity and precision of serum Tn measurement, but this advancement has come at the cost of poorer specificity. The role of clinical judgment is of heightened importance because, more so than ever, the interpretation of serum Tn elevation hinges on the careful integration of findings from electrocardiographic, echocardiographic, physical exam, interview, and other imaging and laboratory data to formulate a weighted differential diagnosis. A thorough understanding of the epidemiology, mechanisms, and prognostic implications of Tn elevations in each cardiac and non-cardiac etiology allows the clinician to better distinguish between presentations of myocardial ischemia and myocardial injury—an important discernment to make, as the treatment of acute coronary syndrome is vastly different from the workup and management of myocardial injury and should be directed at the underlying cause.

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A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part II: Non Cardiac Causes

Cited by 10 publications

References 74 publications

A Case of Type II Achalasia Presenting With Markedly Elevated Troponins

A Case of Type II Achalasia Presenting With Markedly Elevated Troponins

Clinical Biochemistry of Serum Troponin

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

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