Towards appreciating appropriate clinical responses to highly sensitive cardiac troponin assays

Cardiac troponins (cTn) are structural components of the contractile apparatus of the cardiomyocyte and the recommended biochemical markers for diagnosing myocardial infarction. Although the diagnostic performance of both cTnT and cTnI as biochemical markers are quite similar, it is the analytical sensitivities of these assays that have been found to create the difference. High-sensitivity cTn assays, which are capable of measuring cTn levels 10-folds lower than conventional fourth generation assays, are results of continuous effort to develop more sensitive and accurate tests to detect cardiac injury. While the improvement in the sensitivity of these assays promises improvement in many aspects of patient care, such as earlier myocardial infarction diagnosis and cardiac disease risk assessment, shortcoming of these assays must be considered. Very low measurable levels of cardiac damage biochemical markers can deliver occult yet possible decisive message. Better understanding of the pros and cons of these assays will pledge an appropriate clinical reaction to highly sensitive results.