Cardiac Troponin in Autoimmune Rheumatic Diseases: Lights and Shadows

Area of Science:

• Cardiology
• Rheumatology
• Biomarker research

Background:

• Cardiovascular disease is a major concern in autoimmune rheumatic diseases (ARDs).
• Cardiac troponin (cTn) is a key biomarker for myocardial injury, but its interpretation in ARDs is complex.
• Diverse mechanisms, including inflammation and traditional risk factors, contribute to cardiovascular morbidity in ARDs.

Purpose of the Study:

• To review the diagnostic and prognostic value of cardiac troponin (cTn) in autoimmune rheumatic diseases (ARDs).
• To explore the complexities of cTn interpretation in ARDs, considering various confounding factors.
• To assess the role of high-sensitivity cTn assays in identifying myocardial injury and guiding patient management.

Main Methods:

• Systematic literature search of PubMed (1969-November 2025).
• Keywords included specific ARDs, "troponin," "cardiovascular," "myocardial involvement," "cardiac involvement," and "biomarker."
• Review focused on studies evaluating cTn in systemic sclerosis, rheumatoid arthritis, lupus erythematosus, vasculitides, and myopathies.

Main Results:

• High-sensitivity cTn assays detect subclinical myocardial injury and predict adverse cardiovascular events in ARDs.
• cTn elevations can be influenced by comorbidities like renal impairment, infections, and pulmonary hypertension.
• Analytical interferences, such as heterophilic antibodies and rheumatoid factor, can lead to false cTn results in ARDs patients.

Conclusions:

• High-sensitivity cardiac troponin (hs-cTn) shows promise for diagnosing, risk-stratifying, and monitoring cardiac involvement in ARDs.
• Careful interpretation of hs-cTn results within the clinical and laboratory context is crucial for ARDs patients.
• Further research is needed on cTn isoforms, optimal thresholds, and treatment guidance in ARDs populations.