troponin T cardiac in serum/plasma
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Reference interval
- 3.00 pg/mL (3 ng/L) limit of detextion
- < 10 ng/L[3]; < 14 ng/L (elevated)[16]
- < 5 ng/L rules out myocardial infarction (specificity 99.7%)[5][9]*
- < 0.1 ng/mL (0.1 ug/L)[8] <- MKSAP17
- single cardiac troponin-T levels should not be used for the diagnosis of acute myocardial infarction (a significant increase is used)[16]
- 39% of patients with stable ischemic heart disease have levels >= 14 ng/L
- these patients are considered at high risk for cardiovascular events[7].
* elevated levels become detectable > 2 hours after MI with conventional assays
- newer assays are able to detects elevations sooner
- significant change > 5-10 ng/L high-sensitivity troponin-T
* combined with non-ischemic EGG in low-risk patients confers low 30-day risk of major adverse cardiac event[9]
Clinical significance
- elevated cardiac-specific troponin-T indicates myocardial injury due to myocardial ischemia &/or myocardial infarction[8]
- chest pain with an initially elevated high-sensitivity troponin-T without significant change (< 5 ng/L) after 1 hour warrants inpatient observation
- does not confirm myocardial infarction
- does not warrant coronary angiography
- sensitivity: detectable >= 3.00 pg/mL (3.00 ng/L)
- detectable levels may predict left ventricular hypertrophy, heart failure & all-cause mortality[1]
- an algorithm based on changes over a 1-hour period can allegedly rule in or rule out MI in 75% of patients with acute chest pain[4]
- for rule-out, sensitivity & negative predictive value > 99%
- for rule-in, specificity 96% & positive predictive value 78%[6]
- recheck in 2-3 hours
- use of high-sensitivity assay may reduce risk of major cardiac events in patients discharged from the emergency department[11]
- high-sensitivity assay results in an increase in myocardial injury & myocardial infarction diangoses, particularly in women[14]
- overall resource use did not increase, except for angiography
- a negative high-sensitivity assay led to more emergency department discharges & fewer cardiac tests[14]
- variable specificity of mild elevations in patients with ESRD[15]
- levels after non-cardiac surgery predict 30-day mortality[10]
- 18% of patients meet diagnostic criteria for myocardial injury after noncardiac surgery[10]
Increases
- left ventricular hypertrophy
- heart failure
- asymptomatic patients with levels in the top 1/3 with higher risk for incident heart failure than those in the bottom 1/3 (RR=2.1)[13]
- ischemic heart disease[7]
- myocardial injury due to myocardial ischemia &/or myocardial infarction[7]
- myocarditis, pericarditis
- sepsis[7]
- skeletal muscle disease[2]
Procedure
- upon presentation with acute coronary syndrome & 1-4 hour(s) later
- if no significant change in 1-4 hour(s), inpatient observation
Interferences
More general terms
References
- ↑ 1.0 1.1 deFilippi CR et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA 2010 Dec 8; 304:2494. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21078811
de Lemos JA et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010 Dec 8; 304:2503. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21139111 - ↑ 2.0 2.1 Jaffe AS et al. Diseased skeletal muscle: A noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol 2011 Oct 18; 58:1819. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21962825
- ↑ 3.0 3.1 Troponin-T Laboratory Test Directory ARUP: http://www.aruplab.com/guides/ug/tests/0098803.jsp
- ↑ 4.0 4.1 Reichlin T et al One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012 Aug 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22892889 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1309579
Newby LK. Myocardial infarction rule-out in the emergency department: Are high-sensitivity troponins the answer? Arch Intern Med 2012 Aug 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22892634 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1309573 - ↑ 5.0 5.1 Physician's First Watch, April 1, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 6.0 6.1 Reichlin T et al Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ. 2015 May 19;187(8):E243-52. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25869867 <Internet> http://www.cmaj.ca/content/early/2015/04/13/cmaj.141349.full.pdf+html
- ↑ 7.0 7.1 7.2 7.3 7.4 Everett BM et al Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes. N Engl J Med 2015; 373:610-620. August 13, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26267622 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1415921
Melloni C, Roe MT Cardiac Troponin and Risk Stratification in Ischemic Heart Disease. N Engl J Med 2015; 373:672-674. August 13, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26267628 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1506298 - ↑ 8.0 8.1 8.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 19. American College of Physicians, Philadelphia 2015, 2023
- ↑ 9.0 9.1 9.2 Mokhtari A et al. Diagnostic accuracy of high-sensitivity cardiac troponin T at presentation combined with history and ECG for ruling out major adverse cardiac events. Ann Emerg Med 2016 Jul 25 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27471140 <Internet> http://www.annemergmed.com/article/S0196-0644(16)30263-3/abstract
- ↑ 10.0 10.1 10.2 10.3 Writing Committee for the VISION Study Investigators Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017;317(16):1642-1651 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28444280 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2620089
- ↑ 11.0 11.1 Nejatian A et al. Outcomes in patients with chest pain discharged after evaluation using a high-sensitivity troponin T assay. J Am Coll Cardiol 2017 May 30; 69:2622 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28545635
Levy PD. Sense and sensitivity. J Am Coll Cardiol 2017 May 30; 69:2631 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28545636 - ↑ 12.0 12.1 FDA MedWatch Nov 28, 2017 Biotin (Vitamin B7): Safety Communication - May Interfere with Lab Tests. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm586641.htm
- ↑ 13.0 13.1 Evans JDW, Dobbin SJH, Pettit SJ et al High-Sensitivity Cardiac Troponin and New-Onset Heart Failure. A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events. JACC: Heart Failure. January 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29331272 <Internet> http://heartfailure.onlinejacc.org/content/early/2018/01/02/j.jchf.2017.11.003
Jaffe AS, Miller WL. Meta-Analyses and Interpretation of Troponin Values in Heart Failure. JACC: Heart Failure. January 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29331273 <Internet> http://heartfailure.onlinejacc.org/content/early/2018/01/02/j.jchf.2017.12.001 - ↑ 14.0 14.1 14.2 Ola O, Akula A, Di Michieli L et al. Clinical impact of high-sensitivity cardiac troponin T implementation in the community. J Am Coll Cardiol 2021 Jun 29; 77:3160 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34167641 https://www.sciencedirect.com/science/article/abs/pii/S0735109721048208
- ↑ 15.0 15.1 NEJM Knowledge+ Nephrology/Urology
- ↑ 16.0 16.1 16.2 NEJM Knowledge+ Question of the Week September 19, 2023 https://knowledgeplus.nejm.org/question-of-week/2123/
Twerenbold R, Costabel JP, Nestelberger T et al Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. J Am Coll Cardiol. 2019 Jul 30;74(4):483-494. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31345421 Free article.
Sandoval Y, Jaffe AS. Using high-sensitivity cardiac troponin T for acute cardiac care. Am J Med 2017 Dec; 130:1358 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28843652
Neumann JT et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med 2019 Jun 27; 380:2529. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31242362 https://www.nejm.org/doi/full/10.1056/NEJMoa1803377