NEW YORK (Reuters Health) – Recommendations issued by the European Society of Cardiology emphasize the need to consider the clinical context in interpreting cardiac troponin readings in acute cardiac care.
The ESC report on cardiac troponin (cTn), compiled by an expert panel, appears in the European Heart Journal published online August 3. It covers pre-analytical and analytical factors of cardiac troponin assays, interpretation of cardiac troponin test results, measuring cardiac troponin for detection of myocardial infarction, other causes of cardiac troponin release, and the outlook for the highly sensitive cardiac troponin assays in development.
Each of these sections concludes with a summary of critical clinical points. For example, the panelists note, “Clinicians must be aware of the analytical quality and limitations of the cTn assay used in their local laboratory” and “Laboratories should report the 99th percentile value of the reference population.”
“cTn values should be interpreted in proper clinical settings,” the report states, and continues: “An assay-specific cTn decision limit (the 99th percentile value) is mandatory for an immediate management of the patient. However, any detectable cTn value measured with worldwide approved routine cTn assays should be taken into consideration as an indicator of higher risk.”
Another point made is that cTn is the best biomarker for the diagnosis of myocardial necrosis, and for risk stratification of patients with acute MI; however, elevated cTn levels can be due to other causes of cardiac damage. Patients with heart failure, for example, can often have a rising pattern of values.
Meanwhile, the report concludes, “The advent of highly-sensitive cTn assays will herald an era where there will be increased diagnostic information but also additional challenges in the interpretation of test results.”
The current report will be followed by a series of others on the application of various biomarkers in acute cardiac care.
Reference:
Recommendations for the use of cardiac troponin measurement in acute cardiac care
Eur Heart J 2010.
