ACTA FAC. MED. NAISS. 2007;24(3):157-163

  Professional article

CARDIAC TROPONIN RELEASE UNRELATED TO ACUTE CORONARY SYNDROME

Snezana Ciric Zdravkovic

Clinic of Cardiovascular Disease Clinical Center Nis

    SUMMARY

    Cardiac troponin  T and troponin I are the most specific and sensitive laboratory markers of myocardial cell injury. Accordingly, the  definition of acute myocardial infarctions was based on elevations of cardiac troponins in blood in the setting of ischemia. Acute coronary syndrome without ST elevation have attributed troponin measurements a central role in the diagnostic work-up and therapeutic decicisin making. The test results should be available within 30 to 60 minutes, because elevated troponins are helpful in identifying the patients who benefit most from early invasive strategies, anticoagulant therapy with glycoprotein IIb/IIIa antagonists used, and  in low molecular weight heparin (LMWH) therapy. Troponin elevations are mostly, but not necessarily always, related to ischemic cell injury in acute coronary syndrome. An elevation of cTn indicates the presence of, but not the underlying reasons for, myocardial injury. Abnormal values have been described in various conditions not related to acute coronary disease, like myocarditis, pulmonary embolism, acute heart failure, septic shock, and as a result of cardiotoxic drugs as well as after therapeutic procedures, such as coronary angioplasty, electrophysiological ablations, or electrical cardioversions. In intensive care unit, pulmonary embolism and perimyocarditis represent the most important differential diagnosis associated with elevated troponin levels. In acute pulmonary embolism, troponins probably rise because of acute right heart overload. The release is of shorter duration than in unstable angina, and the peak level is linked to the outcome. In histologically confirmed myocarditis, troponins are regularly elevated but also rise in about half of the patients with only clinically suspected myocarditis.

    Key words: acute coronary syndrome, troponins T and I, non-coronary troponin elevation