Using Cardiac Troponins in Patients with Acute Myocardial Infarction
Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) have evolved as the new laboratory criterion standards for the diagnosis of myocardial injury with necrosis and thereby replaced creatine kinase isoenzyme MB (CKMB) as the biomarker of choice in the
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Using Cardiac Troponins in Patients with Acute Myocardial Infarction Johannes Mair and Kristian Thygesen
Abstract Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) have evolved as the new laboratory criterion standards for the diagnosis of myocardial injury with necrosis and thereby replaced creatine kinase isoenzyme MB (CKMB) as the biomarker of choice in the Universal Definition of Myocardial Infarction. Over the last two decades the analytical sensitivities of troponin assays have been constantly improved which has resulted in an improved early diagnostic sensitivity of these cardiac biomarkers for the diagnosis of acute myocardial infarction (AMI). The most recent assays, the so called “high-sensitivity” cardiac troponin assays, have made it possible to introduce rapid rule-out and rule-in protocols for AMI in daily practice. Moreover, the time course of troponin release is greatly influenced by the situation depending on whether early reperfusion of the infarct-related coronary artery is achieved exposing an earlier cTn peak value around 12 h from symptom onset as an expression of emerged reperfusion of the myocardium supplied by this artery. Both cTnI and cTnT show a biphasic release pattern displaying a second peak 4–6 days after the onset of AMI. That is usually more pronounced for cTnT. Furthermore, the amount of troponin release correlates with infarct size and with the prognosis of AMI. Keywords Cardiac troponins • High-sensitivity • Acute myocardial infarction • Diagnosis • Monitoring • Infarct size
J. Mair, MD Department of Internal Medicine III – Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria e-mail: [email protected] K. Thygesen, MD, DSc (*) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2016 A.S. Maisel, A.S. Jaffe (eds.), Cardiac Biomarkers, DOI 10.1007/978-3-319-42982-3_5
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J. Mair and K. Thygesen
Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) are the biomarkers of choice for the diagnosis of myocardial injury with necrosis, because they are the most sensitive and cardiac-specific biomarkers currently available [1, 2]. Over the years the analytical sensitivity of cardiac troponin (cTn) assays has improved continuously and more recently, a new generation of cTn assays, i.e., the high-sensitivity (hs) cTn assays, have been introduced into routine clinical practice [2]. It is important to note, that these assays measure the same analyte as previous assay generations but with substantially improved analytical sensitivity and assay precision at a low measuring range [2]. From a clinical perspective it has been noted that the improved analytical performance of hs-cTn assays also increased their clinical ability to detect small amounts of myocardial injury with necrosis and to more precise identification of small differences in cTn concentrations in serial testing compared with previous cTn assay generations [2]. Thereby hs-cTn a
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