High-Sensitivity Troponin Assays: Analytical Advances, Clinical Benefits, and Ongoing Challenges
High-sensitivity cardiac troponin methods represent the current standard for cTn measurement, offering improved analytical sensitivity that identifies additional patients with myocardial injury who benefit from evidence-based interventions. Rapid predictive algorithms using presentation and 1-2 hour serial samples now enable faster patient categorization to appropriate clinical pathways. While the shift from traditional cardiac enzymes to troponin-based diagnosis has improved MI detection, it has also revealed widespread myocardial injury in non-ACS patients whose optimal management strategy remains undefined.
The original study
High sensitivity troponin, analytical advantages, clinical benefits and clinical challenges - An update.
- Authors
- Collinson P
- Journal
- Clinical biochemistry
- Type
- Journal Article, Review
- PMID
- 33610525
Original abstract
The measurement of cardiac troponin (cTn) by a high sensitivity method now represents the standard method for cTn measurement in the laboratory. High sensitivity method are not measuring a novel form of troponin but have undergone methodological improvement in assay sensitivity to allow both very low level detection and repeat measurements at low levels with very low degrees of analytical imprecision. The methods identify additional patients with myocardial injury who would benefit from evidence-based interventions. Rapid predictive algorithms utilising measurement on admission as well as short sampling periods (1-2 h) allow much more rapid categorisation of patients to appropriate clinical pathways. The shift in the diagnosis from traditional "cardiac enzymes" to troponin based on the 99th percentile has accounted for the majority of the detection of myocardial injury in patients without acute coronary syndromes. These patients have a worse prognosis irrespective of the underlying cause of their hospital admission. The appropriate management strategy in this group, beyond managing the underlying problem, remains to be defined. Measurement of cTn in otherwise asymptomatic individuals may have a role for patient selection for preventive treatment or for patients monitoring. Clinical trials in this area are awaited.