[The clinical role of high-sensitive troponin assays: update, interpretation, and perspectives]

More than thirty years have elapsed since the release of the first criteria of acute myocardial infarction defined by the WHO, but the diagnostic approach to the patients presenting with chest pain remains complex and controversial. Several diagnostic strategies have been proposed, characterized by a variety of algorithms and biochemical markers. The recent introduction of the new cardiac troponin assays, defined "highly-sensitive" and characterized by a higher analytic sensitivity, carries several advantages and some problems. These methods have allowed to identify the continuum of pathophysiological events ranging from an angina attack to the onset of a manifest myocardial infarction, as well as to drastically shorten the triage of the patients because minimum increments of the marker are appreciated much earlier than using the traditional assays. It is also predictable that the usefulness of these highly sensitive methods might be useful beyond the diagnosis of ischemic heart disease, especially for the prospective evaluation of the patients. Nevertheless, the drastic reduction of the diagnostic thresholds, which is a hallmark of this new generation of test, requires a more careful formulation of the reference intervals, a reassessment of the therapeutic strategies, and especially an accurate troubleshooting of the several causes of troponin abnormalities which are not associated with a clear clinical significance. In this context, a close partnership between the clinics and the laboratory is an essential aspect for the appropriate use of the tests and for the accurate interpretation of results.