High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications

Abstract

The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.

Figure 1

Brief history of the cardiac biomarkers. ASAT = aspartate transaminase; LDH = lactate dehydrogenase; CK = creatine kinase; CK-MB = creatine kinase isoenzyme MB.

Figure 2

Sensitivity and sensibility of ASAT, CK, and LDH. ASAT = aspartate transaminase; LDH = lactate dehydrogenase; CK = creatine kinase.

Figure 3

Sensitivity and sensibility over several periods of time from the onset of AMI. AMI = acute myocardial infarction; CK-MB = creatine kinase isoenzyme MB.