High-sensitivity cardiac troponins in everyday clinical practice

Table 1 Analytical characteristics of high-sensitivity cardiac troponin assays

The analytical lower limit of detection is in the range of single digits of ng/L and is markedly lower than the upper reference limit

Hs-cTn assays have high precision in routine use at lower concentration ranges with analytical CV < 10% at the 99th percentile concentration of the reference population

Hs-cTn assays enable detection of cTn in a significant proportion of the reference population, thereby allowing for a more accurate calculation of the 99th percentile URL with its 95% confidence interval

Hs-cTn assays must be highly specific for the detection of cardiac cTn isoforms

Hs-cTn: High-sensitivity cardiac troponin; CV: Coefficient of variation; URL: Upper reference limit.

Table 2 Elevations of high-sensitivity cardiac troponin in the absence of significant coronary artery disease

Acute myocardial damage related to secondary myocardial ischemia (AMI type 2)	Tachycardia or bradycardia (e.g., rapid pacing during transcutaneous aortic valve replacement)
	Aortic dissection with involvement of coronary ostia
	Severe aortic valve stenosis
	Hypertrophic cardiomyopathy
	Hypo- or hyper-tension (e.g., hemorrhagic shock, hypertensive emergency)
	Acute heart failure without significant concomitant CAD
	Severe pulmonary embolism or pulmonary hypertension
	Coronary vasculitis, e.g., systemic lupus erythematosus
	Coronary endothelial dysfunction (spasm) without significant CAD, e.g., cocaine abuse
	Coronary embolism
Acute myocardial damage not related to myocardial ischemia	Cardiac contusion
	Cardiac incisions with surgery
	Radiofrequency or cryoablation therapy for arrhythmias
	Rhabdomyolysis with cardiac involvement
	Myocarditis
	Cardiotoxic agents, e.g., anthracyclines, CO poisoning, severe burns affecting > 30% of body surface
Indeterminate or multiform group	Apical ballooning syndrome
	Renal failure
	Severe acute neurological diseases, e.g., stroke, trauma
	Infiltrative diseases, e.g., amyloidosis, sarcoidosis
	Extreme exertion
	Sepsis
	Acute respiratory failure
	Frequent defibrillator shocks
Analytical interferences	Rare, e.g., by high titres of auto- or hetero-philic antibodies

AMI: Acute myocardial infarction; CO: Carbone monoxide; CAD: Coronary artery disease.