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High-sensitivity methods for cardiac troponins: The mission is not over yet

Aldo Clerico1, Martina Zaninotto2, Claudio Passino1

  • 1Fondazione CNR-Regione Toscana, G. Monasterio, Pisa, Italy; Scuola Superiore Sant'Anna, Pisa, Italy.

Advances in Clinical Chemistry
|July 7, 2021
PubMed

Insights

High-sensitivity cardiac troponin (hs-cTn) assays are crucial for diagnosing Acute Coronary Syndromes. New methods are needed to distinguish reversible from irreversible myocardial injury based on specific circulating troponin forms.

Area of Science:

  • Cardiology
  • Biomarker Analysis
  • Clinical Chemistry

Background:

  • Cardiac troponin (cTn) measurement is the gold standard for diagnosing Acute Coronary Syndromes (ACS).
  • High-sensitivity cardiac troponin (hs-cTn) assays are widely used but present challenges in differentiating myocardial injury mechanisms.
  • Distinguishing between reversible and irreversible cardiomyocyte injury based on biomarker release remains a key clinical concern.

Purpose of the Study:

  • To review critical analytical and clinical issues of current hs-cTn methods.
  • To discuss the potential of novel hs-cTn assays for differentiating myocardial injury.
  • To highlight the need for next-generation hs-cTn assays.

Main Methods:

  • Review of experimental and clinical studies on hs-cTn assays.
  • Analysis of circulating troponin isoforms (cTnI and cTnT) in myocardial injury.
  • Discussion of immunometric immunoassays and chromatographic techniques for novel hs-cTn detection.

Main Results:

  • Current hs-cTn methods struggle to differentiate pathophysiological mechanisms of biomarker release.
  • Distinct circulating forms of cTnI and cTnT are associated with reversible versus irreversible myocardial injury.
  • New assay generations could offer specificity for these different troponin forms.

Conclusions:

  • Next-generation hs-cTn methods, potentially using immunometric immunoassays or chromatography, are needed.
  • These assays should be specific for circulating troponin peptide forms indicative of reversible or irreversible myocardial injury.
  • Such advancements will further refine the diagnosis, prognosis, and management of cardiac diseases.

Keywords:
Cardiac troponinsHarmonizationHigh-sensitivity methodsImmunoassay methodsInterferencesMyocardial infarctionMyocardial injury

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