Recommendations for the use of cardiac troponin measurement in acute cardiac care

Kristian Thygesen, Johannes Mair, Hugo Katus, Mario Plebani, Per Venge, Paul Collinson, Bertil Lindahl, Evangelos Giannitsis, Yonathan Hasin, Marcello Galvani, Marco Tubaro, Joseph S. Alpert, Luigi M. Biasucci, Wolfgang Koenig, Christian Mueller, Kurt Huber, Christian Hamm, Allan S. Jaffe

Research output: Contribution to journalReview articlepeer-review

539 Scopus citations

Abstract

The release of cardiomyocyte components, i.e. biomarkers, into the bloodstream in higher than usual quantities indicates an ongoing pathological process. Thus, detection of elevated concentrations of cardiac biomarkers in blood is a sign of cardiac injury which could be due to supply-demand imbalance, toxic effects, or haemodynamic stress. It is up to the clinician to determine the most probable aetiology, the proper therapeutic measures, and the subsequent risk implied by the process. For this reason, the measurement of biomarkers always must be applied in relation to the clinical context and never in isolation. There are a large number of cardiac biomarkers, but they can be subdivided into four broad categories, those related to necrosis, inflammation, haemodynamic stress, and/or thrombosis. Their usefulness is dependent on the accuracy and reproducibility of the measurements, the discriminatory limits separating pathology from physiology, and their sensitivity and specificity for specific organ damage and/or disease processes. In recent years, cardiac biomarkers have become important adjuncts to the delivery of acute cardiac care. Therefore, the Working Group on Acute Cardiac Care of the European Society of Cardiology established a committee to deal with ongoing and newly developing issues related to cardiac biomarkers. The intention of the group is to outline the principles for the application of various biomarkers by clinicians in the setting of acute cardiac care in a series of expert consensus documents. The first of these will focus on cardiac troponin, a pivotal marker of cardiac injury/necrosis.

Original languageEnglish
Pages (from-to)2197-2204
Number of pages8
JournalEuropean Heart Journal
Volume31
Issue number18
DOIs
StatePublished - Sep 2010
Externally publishedYes

Bibliographical note

Funding Information:
Conflicts of interest: K.T. has received lecture honoraria from Roche Diagnostics and Dade Behring; J.M. received lecture honoraria from Siemens Medical Solutions and minor consulting fees from Abbott Diagnostics and Philips; H.K. holds a patent on the cardiac troponin T assay jointly with Roche Diagnostics. A.S.J. has received consulting honoraria from most of the major diagnostic companies including Beckman-Coulter and Siemens; M.T. has been member of the advisory boards of Roche Diagnostics and Abbott Diagnostics and he has received lecture honoraria from Biosite/Inverness, Abbott Diagnostics, and Dade Behring; J.S.A. received lecture honoraria from Roche Diagnostics and Siemens Diagnostics; L.M.B. has been consultant for Siemens Diagnostics, Roche Diagnostics, and Abbott Diagnostics; P.C. has been consultant for Dade Behring; M.P. has been consultant for Siemens Diagnostics; C.H. has been consultant for Abbott Diagnostics and Roche Diagnostics; E.G. received lecture honoraria from Roche Diagnostics, Bayer Vital, Mitsubishi Chemicals, and was consultant for Roche Diagnostics; C.M. received lecture honoraria from Abbott Diagnostics, Biosite, Brahms, Roche Diagnostics, Siemens Diagnostics and he has received support from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Abbott Diagnostics, Biosite, Brahms, Nanosphere, Roche Diagnostics, and Siemens Diagnostics; B.L. has been member of the advisory board for Beckman Coulter and Siemens Diagnostics and he received lecture honoraria from Siemens Diagnostics and Roche diagnostics; M.G. has been consultant for Roche Diagnostics and he has received research grants from Roche Diagnostics, Siemens Diagnostics, and Beckman Coulter; P.V. has received lecture honoraria and research grants from Abbott, Beckman Coulter, Roche Diagnostics, Siemens and is currently consultant for Philips and Radiometer.

Keywords

  • 99th percentile decision level
  • Cardiac biomarkers
  • Cardiac troponin I
  • Cardiac troponin T
  • Cardiac troponins
  • Myocardial infarction
  • Myocardial injury
  • Myocardial necrosis
  • Troponin assay impression
  • Troponin assays

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