From the Research
A patient with chronic low elevation of troponin is at increased risk for an adverse cardiac event if their high-sensitivity troponin (hs-troponin) triples, and this significant change should prompt immediate clinical evaluation. The most recent and highest quality study, published in the Journal of the American College of Cardiology in 2023 1, found that troponin concentrations were associated with the primary outcome of myocardial infarction or cardiovascular death after adjusting for cardiovascular risk factors and coronary artery disease severity. This suggests that even in patients with chronic elevations, a significant dynamic change in troponin levels provides valuable prognostic information and helps distinguish between chronic and acute cardiac pathology.
Key Considerations
- The absolute change in troponin concentration is more important than the relative percentage change, and serial measurements should be taken to establish the pattern.
- If the tripling represents an acute change rather than analytical variation, urgent cardiac evaluation is warranted, including ECG, echocardiogram, and possible cardiac catheterization depending on clinical presentation.
- Chronic elevations can occur in conditions like renal failure, heart failure, or advanced age, but a significant dynamic change suggests acute myocardial injury.
- The underlying pathophysiology involves increased release of troponin from damaged cardiomyocytes, which can occur during acute coronary syndromes, myocarditis, or other acute cardiac conditions.
Clinical Implications
- The study by 1 highlights the importance of troponin testing in risk stratification of patients with chronic coronary artery disease, independent of disease severity and conventional risk measures.
- Another study published in Circulation in 2019 2 found that elevated high-sensitivity troponin I is strongly associated with increased global cardiovascular disease incidence in the general population, independent of traditional risk factors.
- However, it is essential to consider the clinical context and potential comorbidities, such as chronic kidney disease, when interpreting troponin levels, as noted in the review published in Reviews in Cardiovascular Medicine in 2020 3.