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22 September 2019 : Review article  

Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease

Michael Sternberg1EF, Evasio Pasini2EF, Carol Chen-Scarabelli3EF, Giovannii Corsetti4EF, Hemang Patel5EF, Daniele Linardi6EF, Francesco Onorati6EF, Giuseppe Faggian6EF, Tiziano Scarabelli3EF*, Louis Saravolatz7EF

DOI: 10.12659/MSM.915830

Med Sci Monit 2019; 25:7115-7125

Abstract

In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.

Keywords: Biological Markers, Coronary Artery Disease, Myocardial Ischemia, troponin, Models, Biological, Myocardium

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750