by What are Troponin Industry?
Cardiac biomarkers are substances released into the bloodstream when the heart muscle is damaged or stressed. There are several cardiac biomarkers released during a heart attack but troponin is considered the gold standard biomarker for the detection and diagnosis of myocardial infarction or heart attack.
History and discovery of Troponin Industry
Troponin was first identified in the 1960s as a complex of three regulatory proteins (troponin C, I, and T) that are essential for muscle contraction. In the 1980s, studies found that troponin levels rose following a myocardial infarction. This led to the development of high-sensitivity troponin assays in the late 1990s and early 2000s. Troponin is now universally regarded as the most reliable biomarker for the diagnosis of myocardial infarction.
How does troponin work?
Global Troponin is only found in heart muscle cells. When heart cells are damaged during a heart attack, troponin leaks out of the damaged cells and into the bloodstream. Troponin levels usually start to rise 3-4 hours after the onset of chest pain from a heart attack. Peak levels are reached within 24 hours. Troponin remains elevated and detectable in the blood for up to 2 weeks after a heart attack. This makes troponin very useful for the diagnosis of heart attacks, even when someone presents days after the initial event.
Troponin testing anddiagnosis of heart attacks
Current guidelines recommend troponin testing be performed on patients who present with symptoms suggestive of an acute coronary syndrome like chest pain or shortness of breath. Two samples taken 6 hours apart are recommended – if troponin is elevated above the 99th percentile upper reference limit in both samples, the diagnosis of myocardial infarction is made. More sensitive high-sensitivity troponin (hs-TnT and hs-TnI) assays can detect lower levels of troponin and are increasingly used in emergency departments to rule out heart attacks earlier. A single undetectable hs-Tn level on arrival to the ED has a very high negative predictive value ruling out a heart attack.
Troponin in different patient populations
Troponin is used not just to diagnose heart attacks but also to provide important prognostic information. In patients with symptoms of heart failure, an elevated troponin level indicates worse prognosis and greater risk of adverse events. Chronic kidney disease patients often have elevated baseline troponin levels due to increased cardiac workload, however rising or falling levels still indicate worsening or improving cardiac status. Troponin is also a powerful risk marker in acute coronary syndrome patients, with higher levels linked to larger infarct size and increased mortality.
Global differences in troponin testing
While troponin is established globally as the cornerstone biomarker for the diagnosis of myocardial infarction, there are some differences in troponin testing practices between countries and regions. In the USA, Europe and other western countries, high-sensitivity troponin assays allowing earlier rule-out of heart attack are more widely used in emergency departments. However, conventional troponin assays remain standard in other regions like parts of Asia due to cost and availability issues. Reference limits and levels indicating MI also vary between assays from different manufacturers worldwide. Standardization continues to be important for consistent diagnosis globally.
Future directions of troponin
As cardiac biomarkers continue to evolve, troponin still remains the gold standard. However, newer high-sensitivity assays are paving the way for more rapid diagnosis and rule-out of heart attack within 1-2 hours. Novelforms of troponin like cardiac troponin ultrasound are being developed which may allow point-of-care testing outside of hospitals. Newer biomarkers complementary to troponin are also being investigated like heart-type fatty acid binding protein which may provide additional prognostic information. With further refinements to assays and standardization, troponin testing will likely remain the cornerstone of rapid diagnosis of heart attack for years to come on a global scale.
Troponin has revolutionized the diagnosis and management of acute myocardial infarction since its identification and implementation in clinical practice in the late 20th century. Though testing practices vary globally, troponin remains universally accepted as the gold standard biomarker for the detection of cardiac necrosis resulting from acute coronary syndromes. Continued advancements in sensitive assays will allow for earlier rule-out and more tailored treatment strategies worldwide. Troponin testing holds an integral role in cardiovascular medicine presently and promises to do so well into the future.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
