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Do We Really Understand Troponin?

Do We Really Understand Troponin?

With the advancement of clinical laboratory technology, the sensitivity of point of care troponin testing has been increasing, which is highly beneficial for early identification of myocardial infarction and improving prognosis. Improving sensitivity reduces missed diagnoses, but it also leads to misdiagnoses of many non-myocardial infarction patients who receive unnecessary treatment. In a situation where high-sensitivity cardiac troponin is prevalent, it is essential to interpret elevated levels of cardiac troponin scientifically.

The current interpretation of elevated point of care troponin testing in clinical practice

What does elevated cardiac troponin mean? The first answer used to be acute myocardial infarction (AMI). However, due to the emergence of "high-sensitivity cardiac troponin" and "ultra-sensitive cardiac troponin," this answer is no longer accurate.

Clinicians have insufficient knowledge of new insights into high-sensitivity cardiac troponin, and there is not enough promotion and communication between clinical medicine and laboratory testing. Moreover, some quality problems exist with laboratory testing, which cannot ensure the accuracy and controllability of the results.

These problems have occurred in Europe a few years ago and will also be encountered in the United States as the FDA will soon approve its use in clinical practice. However, before formal use, the Americans did a lot of work and formed some "consensus," the primary purpose of which was to let clinicians know how to apply it best and scientifically and rationally interpret the results.

The role of high-sensitivity point of care troponin testing in AMI diagnosis

With the continuous progress of medicine, biomarkers for myocardial infarction or injury are constantly changing and developing. From the "traditional myocardial enzyme spectrum" to the once "gold standard" CK-MB, and to the most specific myocardial injury/necrosis biomarker so far - cardiac troponin T/I; from "myocardial infarction biomarkers" to "myocardial injury biomarkers"; from simple myocardial infarction diagnosis to the presentation of acute coronary syndrome (ACS) and risk stratification concepts, the value of cardiac troponin in the diagnosis and prognosis of myocardial infarction is gradually increasing.

We must know that point of care troponin testing is a laboratory test for detecting myocardial necrosis/injury, while myocardial infarction is a clinical diagnosis. The interpretation of any laboratory test results cannot be divorced from the clinical context. Do not forget that the main challenge of applying hs-cTn to clinical practice is inappropriate testing and incorrect interpretation of the results, not the biomarker itself.

The cornerstone of ACS diagnosis is still a complete and detailed medical history, and the combination of electrocardiogram and cTn is the core of current diagnosis. In short, "clinical context is the key." Only by using it correctly can we be "adept" in interpreting, diagnosing, risk stratifying, and managing patients.