An elevated troponin concentration is determined by a value greater than the 99th percentile of a normal population. Thses values were hardly to be exceeded when using the troponin assays in the early stage, except in the condition of AMI. Historically, the two sensitive troponin assays are now gold standard and reference assays for AMI diagnosis. Other biomarkers for AMI such as CK, CK-MB, etc, since they aspartate amino transferase and lactate dehydrogenase which are not as stable as troponin lead them to limited importance.
Fouth generation troponin T (cTnT) and the high-sensitivity TnT (hsTnT) assays are first developed more than 20 years ago. With each new generation of troponin assays, clinicians have to do clinical trials to determine the utility of this biomarker in clinical practice. The list of causes for an abnormally elevated troponin has increased, in another hand, the improvements in the assays and the more sensitive detection limits. Elevations could be observed in several pathological conditions, including heart disease, renal impairment and pulmonary embolism, but might also be seen in extreme exertion, such as marathon runners.
So, how should the high sensitive troponin assay be used in clinicals? Normally in ER, assays are used to rule-in AMI which has been already recognized. Perhaps a greater interest lies in the ability of hs-Tn assay to allow the earlier rule-out AMI in early stage, but is is not identified yet. Verification of this will allow accelerated assessment protocols to be developed, with patients rapidly progressing
to provocative testing for inducible ischaemia at a much earlier time, even same day, following negative serial
biomarkers and ECGs.
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