Troponin interference with special regard to macrocomplex formation

Abstract

Biomarkers, such as troponin-T and troponin-I, are regarded as the gold standard laboratory parameter for diagnosing many cardiological diseases. These parameters have been approved for clinical use. Many cardiological guidelines recommend the analysis of troponins in the majority of cardiological disease diagnoses and to also gain prognostic information. Nonetheless, many medical circumstances could cause false troponin elevations. In this article, we focus on troponin artifacts, particularly macro-immune complex formation, as important interference factors. Therefore, we performed a literature search from 2006 to 06/2021.

Skeletal Muscle Disorders: A Noncardiac Source of Cardiac Troponin T

“…7,17 Alternative explanations need to be considered in these patients such as analytic interference attributable to heterophilic antibodies, autoantibodies, or the formation of macrotroponin complexes, which seem to affect hs-cTnI more commonly than hs-cTnT. 43–47 The interpretation of CK-MB is difficult because it has cardiac and skeletal muscle sources and is re-expressed in diseased skeletal muscle. 3…”

“…7,17 Alternative explanations need to be considered in these patients such as analytic interference attributable to heterophilic antibodies, autoantibodies, or the formation of macrotroponin complexes, which seem to affect hs-cTnI more commonly than hs-cTnT. [43][44][45][46][47] The interpretation of CK-MB is difficult because it has cardiac and skeletal muscle sources and is re-expressed in diseased skeletal muscle. 3 Contrary to what was expected, the prevalence of hs-cTnT/I mismatch was higher in the overall group, with about half having documented cardiac disease compared with the subgroup without cardiac disease (36%-50% versus 33%-37%).…”

Four high sensitivity troponin assays and mortality in US adults with cardiovascular disease: The national health and nutrition examination survey, 1999–2004

“…Indeed, modest concordance across hs-troponin assays has been previously noted in acutely symptomatic patients with suspected MI [22] , [23] , [24] . Hs-troponin assays are also heterogeneously affected by heterophile-antibodies, macro-troponin, and spuriously elevated results (so-called ‘fliers’) [25] , [26] , [27] , [28] , [29] , [30] . These considerations, along with the independent associations of each of the hs-troponin I assays with events, suggests that there may be fundamental differences in what is being measured by these hs-troponin I assays.…”