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La Rivista Italiana della Medicina di Laboratorio 2021 Settembre;17(3):154-64

DOI: 10.23736/S1825-859X.21.00116-X


language: Italian

Updated information about methods of identification and diagnostic opportunities of cardiac troponins

Aleksey M. CHAULIN

Facoltà di Cardiologia e Chirurgia Cardiovascolare, Università Statale di Samara, Samara, Russia

The abilities of laboratory diagnostics of multiple diseases, cardiovascular included, are constantly improving due to significant enhancement of test methods of biomarkers in human body fluids. As the laboratory diagnostics methods are being improved, our perception of cardio markers biology and their diagnostic consideration are being changing as well, and diagnostic opportunities for their use are also being disclosed. For instance, the immunochemical methods of identifying cardio-specific cardiac troponins (cTnI, cTnT), which were first developed over 30 years ago, had a relatively small sensitivity and thus were of a low value for clinical practice, as such methods could detect only large-focal myocardial infarction in the late stages of its progression, without any therapeuticаl advantages. Certain immunochemical methods of identifying cTnI, cTnT also were of small specificity, which was expressed in form of cross-reactions between diagnostic anti-cTnI and anti-cTnT with skeletal isoforms of troponins at various muscle disorders (rhabdomyolysis, genetical and acquired myopathies) and to a high extent contributed to appearing of probably false hypotheses on existence of the expression of cardio-specific troponin isoforms in skeletal muscles. Enhancement of methods of identifying cTnI and cTnT was accompanied by gradual improving of sensitivity and ability to detect acute myocardial infarction (AMI) and to determine the treatment approach at earlier periods from the moment of a patient admission. The identification methods implemented by now and designated as high- and ultrasensitive (hs-cTnI and hs-cTnT) allowed conducting AMI diagnostics during the first hours from the moment of occurring of a typical pain syndrome (diagnostic algorithms 0-1, 0-2, 0-3 hours); however, specificity of these research methods in relation to ischemic myocardial injury per se was negatively affected to rather a large extent. For instance, even insignificant injures of cardiomyocytes which can occur at physiological (physical exercise, age peculiarities, circadian rhythms, stress situations typical for one’s routine life) and in early stages of a number of disease conditions (various types of myocarditis, sepsis, oncology diseases, ecc.) can invoke increases of hs-cTnI and hs-cTnT levels of the type, which opens up new opportunities of use. Study of hs-cTnI and hs-cTnT in non-invasive human body fluids (urine and saliva) is a very intriguing and perspective direction, which possesses certain advantages in comparison with serum test. In this review, I generalize the actual information about methods of identification and diagnostic opportunities of hs-cTnI and hs-cTnT.

KEY WORDS: Myocardial infarction; Diagnosis; Troponin; Review

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