Increased cardiac troponins, not associated with acute coronary syndrome. Part 1

• Chaulin Aleksey M.
• Duplyakov Dmitriy V.

Abstract

The aim of the review was to describe causes and mechanisms which underlie increased cardiac troponins levels in patients without established myocardial infarction. Wide-scale introduction of high-sensitivity analysis for troponins determination in common use, which has reached the greatest distribution in Europe, has led to a significant quickening of theranostic and clinical outcome prediction processes. However, there is also a negative side in supersensitive methods: higher ability to detect troponins leads to lower specificity, which can make it difficult and/or lead to errors in differential diagnostics, especially if clinicians will rely only on laboratory findings. At the moment it has not yet been clearly identified what role subclinical myocardial injury can play in case of apparently healthy humans. At the same time, most researchers note the importance of affecting myocardium malconditions monitoring, since circulating concentration of troponins in these nosologies strongly correlate with further clinical prognosis. Hot topic for differential diagnostics improvement is establishment of exact mechanisms for increase in troponin levels to assess comparative kinetics of concentration, which, of course, must be taken into account in order to improve fast diagnostic algorithms for acute coronary syndrome.

In the first part of the review we discuss a number of commonly encountered conditions that are accompanied by an increase in cardiac isoforms of troponins which is not associated with acute coronary syndrome: physical activity and psychoemotional stress; chronic renal failure, pulmonary artery thromboembolia, sepsis, and skeletal muscle disorders.

The second part is devoted to clinicodiagnostic importance and mechanisms of cardiac troponins Levels elevation in myocarditis, cardiomyopathies, takotsubo syndrome, cardiac decompensation, inflammatory processes with myocardial tissue involvement, tachyarrhythmias, aortic dissection, autoimmune myocardial damage, brain injury (cerebral hemorrhages, subarachnoidal hemorrhages). Considerable attention is paid to troponins usage for evaluation of drugs cardiotoxicity in connection with recent appearance of a new interdisciplinary section - cardiac oncology. In conclusion false-positive and false-negative interference factors that accompany analytical and preanalytical stages of laboratory assessment are considered: heterophile antibodies and autoantibodies, including rheumatoid factor, hemolysis, etc.

Keywords:troponins I and T, high-sensitivity troponins, myocardial injury, myocardial infarction, noncoronary causes of elevated troponins, chronic renal, failure, sepsis, exercise, pulmonary embolism, myopathies

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)