Cardiac troponin

Abstract

Cardiac troponin (cTn) testing plays a crucial role in the diagnosis of cardiovascular diseases, particularly acute coronary syndrome (ACS), which includes acute myocardial infarction (AMI). However, conventional immunoassays may be subject to interference from autoantibodies, cross-reactivity, and biotin-related effects, compromising diagnostic accuracy. A thorough investigation of these interference mechanisms is necessary to improve assay methodologies, ensuring greater reliability and precision. In recent years, significant advancements in mass spectrometry (MS) technology have sparked increased interest in its application for cTn testing. For instance, liquid chromatography-tandem mass spectrometry (LC-MS/MS) employs multiple reaction monitoring (MRM) to accurately quantify cardiac troponin I (cTnI)-specific tryptic peptides along with their fragment ions. This technique effectively reduces immunoassay interference while improving analytical specificity. Compared to traditional immunoassays, MS-based approaches alleviate matrix effects and analytical interferences while achieving superior specificity. Nonetheless, clinical adoption remains constrained by technical complexity; thus clinicians can obtain more reliable diagnostic insights. This review summarizes the current landscape of cTn detection technologies by examining the prevalence of false-positive results across various methods. It further explores both the practical applications and challenges associated with MS-based techniques in cTn testing. Ultimately, this review aims to improve cTn testing reliability, enhance cardiovascular disease diagnosis, and guide personalized treatment strategies.

Keywords: Cardiac troponin; Immunoassay; Immunoassay interference; Mass spectrometry; Standardization.