Skip to main content
SpringerLink
Log in

Troponin Basics for Clinicians

  • Chapter
  • First Online:
Cardiac Biomarkers

  • 1538 Accesses

Abstract

Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI), including each specific MI subtype (i.e., type 1–5 acute myocardial infarction), due to cTn’s high myocardial tissue specificity and high clinical sensitivity [1]. cTn are regulatory proteins with both cytosolic (predominant) and structural pools (minor) [2]. Clinical implementation of cTnT and cTnI assays in the late 1980s revolutionized the diagnostic approach of patients with symptoms suspicious for AMI [3, 4]. Global utilization of high-sensitivity (hs) cTnI and cTnT assays has brought upon clinicians another transformational stage in the diagnostic approach of patients presenting with symptoms suspicious for AMI. It is essential for clinicians, in particular emergency physicians and cardiologists, to understand the nuances of cTn testing, as proper understanding of the analytical characteristics of assays will lead to sound clinical implementation and improved research observations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–98.

    Article  PubMed  Google Scholar 

  2. Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006;48:1–11.

    Article  CAS  PubMed  Google Scholar 

  3. Cummins B, Auckland ML, Cummins P. Cardiac-specific troponin-I radioimmunoassay in the diagnosis of acute myocardial infarction. Am Heart J. 1987;113:1333–44.

    Article  CAS  PubMed  Google Scholar 

  4. Katus HA, Remppis A, Looser S, Hallermeier K, Scheffold T, Kübler W. Enzyme linked immune assay of cardiac troponin T for the detection of acute myocardial infarction in patients. J Mol Cell Cardiol. 1989;21:1349–53.

    Article  CAS  PubMed  Google Scholar 

  5. Armbruster DA, Pry T. Limit of blank, limit of detection and limit of quantitation. Clin Biochem Rev. 2008;29 Suppl 1:S49–52.

    PubMed  PubMed Central  Google Scholar 

  6. Sandoval Y, Smith SW, Apple FS. Present and future of cardiac troponin in clinical practice: a paradigm shift to high sensitivity assays. Am J Med. 2016;129(4):354–65.

    Article  CAS  PubMed  Google Scholar 

  7. Body R, Carley S, McDowell G, Jaffe AS, France M, Cruickshank K, Wibberley C, Nuttal M, Mackway-Jones K. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol. 2011;58:1332–9.

    Article  PubMed  Google Scholar 

  8. Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol. 2014;63:2569–78.

    Article  CAS  PubMed  Google Scholar 

  9. Body R, Burrows G, Carley S, Cullen L, Than M, Jaffe AS, Lewis PS. High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation. Clin Chem. 2015;61:983–9.

    Article  CAS  PubMed  Google Scholar 

  10. Apple FS, Collinson PO, IFCC Task Force on Clinical Applications of Cardiac Biomarkers. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem. 2012;58:54–61.

    Article  CAS  PubMed  Google Scholar 

  11. Apple FS, Hollander J, Wu AH, Jaffe AS. Improving the 510(k) FDA process for cardiac troponin assays: in search of common ground. Clin Chem. 2014;60:1273–5.

    Article  CAS  PubMed  Google Scholar 

  12. Shah AS, Anand A, Sandoval Y, et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet. 2015. doi:10.1016/S0140-6736(15)00391-8.

    Google Scholar 

  13. Dawson B, Trapp RG. Basic & clinical biostatistics. New York: Lange Medical – McGraw Hill, Medical Pub. Division; 2004.

    Google Scholar 

  14. Omar F. Essential laboratory knowledge for the clinician. Continuing medical education. 2012;30(7):244–48. ISSN 2078–5143. Available at: http://www.cmej.org.za/index.php/cmej/article/view/2524/2433.

  15. Apple FS. A new season for cardiac troponin assays: it’s time to keep a scorecard. Clin Chem. 2009;55:1303–6.

    Article  CAS  PubMed  Google Scholar 

  16. Sandoval Y, Smith SW, Schulz KM, Murakami MM, Love SA, Nicholson J, Apple FS. Diagnosis of type 1 and type 2 myocardial infarction using a high-sensitivity cardiac troponin I assay with sex-specific 99th percentiles based on the third universal definition of myocardial infarction classification system. Clin Chem. 2015;61:657–63.

    Article  CAS  PubMed  Google Scholar 

  17. Korley FK, Jaffe AS. Preparing the United States for high-sensitivity cardiac troponin assays. J Am Coll Cardiol. 2013;61:153–8.

    Article  Google Scholar 

  18. Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA, Fesmire FM, Geraci SA, Gersh BJ, Larsen GC, Kaul S, McKay CR, Philippides GJ, Weintraub WS. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012;60:2427–63.

    Article  PubMed  Google Scholar 

  19. Sandoval Y, Apple FS. The global need to define normality: the 99th percentile value of cardiac troponin. Clin Chem. 2014;60:455–62.

    Article  CAS  PubMed  Google Scholar 

  20. Apple FS, Jaffe AS, Collinson P, et al. IFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays. Clin Biochem. 2015;48:201–3.

    Article  CAS  PubMed  Google Scholar 

  21. Shah AS, Griffiths M, Lee KK, et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ. 2015;350:7873. doi:10.1036/bmj.g7873.

    Article  Google Scholar 

  22. Gore MO, Seliger SL, Defilippi CR, et al. Age- and sex-dependent upper-reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol. 2014;63:1441–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vasikaran SD, Bima A, Botros M, Sikaris KA. Cardiac troponin testing in the acute care setting: ordering, reporting, and high sensitivity assays—an update from the Canadian society of clinical chemists (CSCC); the case for age related acute myocardial infarction (AMI) cut-offs. Clin Biochem. 2012;45:513–4.

    Article  PubMed  Google Scholar 

  24. Apple FS, Murakami MM. Serum and plasma cardiac troponin I 99th percentile reference values for 3 2nd-generation assays. Clin Chem. 2007;53:1558–60.

    Article  CAS  PubMed  Google Scholar 

  25. Apple FS, Ler R, Murakami MM. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012;58:1574–81.

    Article  CAS  PubMed  Google Scholar 

  26. Amundson BE, Apple FS. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction. Clin Chem Lab Med. 2015;53:665–76.

    Article  CAS  PubMed  Google Scholar 

  27. Jaffe AS, Moeckel M, Giannitsis E, et al. In search for the Holy Grail: suggestions for studies to define delta changes to diagnose or exclude acute myocardial infarction: a position paper from the study group on biomarkers of the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care. 2014;3:313–6.

    Article  PubMed  Google Scholar 

  28. Keller T, Zeller T, Ojeda F, et al. Serial changes in highly sensitive troponin I assay and early diagnosis of myocardial infarction. JAMA. 2011;306:2684–93.

    Article  CAS  PubMed  Google Scholar 

  29. Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J. 2012;33:2252–7.

    Article  CAS  PubMed  Google Scholar 

  30. Reichlin T, Irfan A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation. 2011;124:136–45.

    Article  CAS  PubMed  Google Scholar 

  31. Mueller M, Biener M, Vafaie M, et al. Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem. 2012;58:209–18.

    Article  CAS  PubMed  Google Scholar 

  32. Reichlin T, Schindler C, Twerenbold R, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 2012;172:1211–8.

    Article  PubMed  Google Scholar 

  33. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267–315.

    Article  PubMed  Google Scholar 

  34. Carlton EW, Cullen L, Than M, Gamble J, Khattab A, Greaves K. A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin. Heart. 2015;101:1041–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sherwood MW, Newby KL. High-sensitivity cardiac troponin assays: evidence, indications and reasonable use. J Am Heart Assoc. 2014;3:e000403.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wu AH. Biological and analytical variation of clinical biomarkers testing: implications for biomarker-guided therapy. Curr Heart Fail Rep. 2013;10:434–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Hennepin County Medical Center/Abbott Northwestern Hospital, Minneapolis, MN, USA

    Yader Sandoval MD

  2. Clinical Laboratories, Hennepin County Medical Center, Minneapolis, MN, USA

    Fred S. Apple PhD

  3. Department of Laboratory Medicine and Pathology, University of Minnesota in Minneapolis, Minneapolis, MN, USA

    Fred S. Apple PhD

Authors
  1. Yader Sandoval MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fred S. Apple PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fred S. Apple PhD .

Editor information

Editors and Affiliations

  1. Division of Cardiovascular Medicine, University of California San Diego Division of Cardiovascular Medicine, La Jolla, California, USA

    Alan S. Maisel

  2. Cardiology Department, Mayo Clinic Cardiology Department, ROCHESTER, Minnesota, USA

    Allan S. Jaffe

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Sandoval, Y., Apple, F.S. (2016). Troponin Basics for Clinicians. In: Maisel, A., Jaffe, A. (eds) Cardiac Biomarkers. Springer, Cham. https://doi.org/10.1007/978-3-319-42982-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42982-3_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42980-9

  • Online ISBN: 978-3-319-42982-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation