HIGH SENSITIVITY TROPONINS: A STEP FORWARD OR AN UNREQUESTED COMPLICATION?
Luigi M. Biasucci, M.D., Catholic University of the Sacred Heart Largo, Rome, Italy
Progressive improvement in the analytical sensitivity of troponin (cTn) assays has led to a more rapid diagnosis of AMI and improved risk stratification in patients with NSTE-ACS, several authors have found that hs-troponin allow a faster and more accurate diagnosis of myocardial infarction (AMI), allowing detection of almost all MI in the first 3 to 6 hours. However, at the same time, hs-troponin has introduced the problem of a lower diagnostic specificity. It is of remarkable importance to consider that cTn is not a specific marker of AMI, caused by myocardial ischemia, but is a specificity as marker of myocardial damage, that could be due to other mechanisms. Therefore, hs-Tn assays are able to detect very small increases in the biomarker concentration and may result “positive” in a wide range of non-ischemic clinical conditions, acute and chronic, cardiac and extra-cardiac, such as pericarditis, myocarditis, tachyarrhythmias, heart failure, pulmonary embolism, stroke and sepsis thus current guidelines recommend that for a diagnosis of AMI, it is necessary to observe a rise and fall of hs-Tn.. Persistent, but without a rise and fall pattern, elevation of hs-Tn can be found in patients with stable coronary artery disease (chronic renal failure, chronic heart failure and severe left ventricular hypertrophy. Therefore, hsTn significantly increase the detection of AMI but require a careful evaluation of possible false positive cases.