Elevated cardiac troponins: the ultimate marker for myocardial necrosis, but not without a differential diagnosis

Area of Science:

• Cardiology
• Biochemistry
• Clinical Diagnostics

Background:

• Cardiac troponins (cTn) are biomarkers released from damaged heart muscle cells.
• Elevated cTn levels are significant for diagnosing acute myocardial infarction (MI), risk stratification, and treatment decisions.
• However, cTn elevation is not exclusive to MI.

Purpose of the Study:

• To review the differential diagnoses for elevated cardiac troponin levels beyond acute myocardial infarction.
• To highlight the importance of considering alternative causes of troponin elevation.
• To prevent over-diagnosis of MI and misattribution of the underlying condition.

Main Methods:

• Literature review of studies reporting non-MI causes of cardiac troponin elevation.
• Analysis of conditions associated with elevated troponin, including non-thrombotic cardiac injury, systemic diseases, and laboratory interferences.

Main Results:

• Numerous conditions can cause elevated cardiac troponin levels, mimicking MI.
• These include, but are not limited to, non-thrombotic cardiac injury and systemic diseases.
• Laboratory errors or interferences can also lead to falsely elevated troponin.

Conclusions:

• Physicians must recognize that elevated cardiac troponin does not always indicate acute MI.
• A thorough differential diagnosis is essential to identify the true cause of troponin elevation.
• Avoiding misdiagnosis of MI is critical for appropriate patient management and treatment.