Falsely elevated troponin: rare occurrence or future problem

Area of Science:

• Cardiology
• Clinical Chemistry
• Laboratory Medicine

Background:

• Cardiac troponins (cTn) are established biomarkers for diagnosing acute myocardial infarction (AMI).
• Elevated cTn levels are crucial for early AMI diagnosis and improved patient outcomes.
• Assay interference can lead to inaccurate cTn results, complicating diagnosis.

Observation:

• A patient presented with symptoms suggestive of cardiac events, exhibiting elevated troponin levels over several years.
• Despite elevated troponin, cardiac evaluations including catheterization and CT scans revealed no obstructive coronary artery disease.
• Further investigation, including sample dilution and testing at a different facility, indicated falsely elevated troponin levels.

Findings:

• The case demonstrates a scenario of persistently elevated troponin levels in the absence of clinical or diagnostic evidence of myocardial infarction.
• Interference in troponin immunoassays, potentially due to various factors, can lead to false-positive results.
• Confirmation of false elevation was achieved by comparing results from different immunoassay methods.

Implications:

• Clinicians must consider assay interference and non-AMI etiologies when interpreting elevated troponin levels, especially in ambiguous cases.
• The increasing use of immunotherapies and radiolabeled antibodies may increase the prevalence of troponin assay interference.
• A high index of suspicion for false-positive troponin results is essential for accurate patient management and to avoid unnecessary interventions.