From the Guidelines
Troponin elevation is a biomarker of myocardial injury with necrosis, and a value above the 99th percentile of the upper reference level is required for the diagnosis of acute myocardial necrosis, with evidence of a serial increase or decrease ≥20% if the initial value is elevated 1. The diagnosis of myocardial infarction (MI) is based on the detection of myocardial injury with necrosis, and troponin elevation is a key biomarker for this condition. According to the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, troponin values must manifest an acute pattern consistent with the clinical events, including ischemic symptoms and electrocardiographic changes 1. Some key points to consider when interpreting troponin elevation include:
- A troponin value above the 99th percentile of the upper reference level is required for the diagnosis of acute myocardial necrosis 1
- Evidence for a serial increase or decrease ≥20% is required if the initial value is elevated 1
- Absolute changes in nanograms per liter of high-sensitivity cardiac troponin T levels appear to have a significantly higher diagnostic accuracy for AMI than relative changes 1
- Troponin elevations can be due to various causes, including MI, myocarditis, cardiac trauma, acute heart failure, and severe noncardiac conditions such as sepsis, burns, and respiratory failure 1
- Chronic elevations can result from structural cardiac abnormalities, such as left ventricular hypertrophy or ventricular dilatation, and are also common in patients with renal insufficiency 1 The third universal definition of myocardial infarction also emphasizes the importance of troponin elevation in the diagnosis of MI, and defines myocardial injury with necrosis as a value exceeding the 99th percentile of a normal reference population [upper reference limit (URL)] 1. In clinical practice, it is essential to consider the clinical context and other diagnostic information when interpreting troponin elevation, as solitary elevations of troponin cannot be assumed to be due to MI 1. Some other conditions that can cause troponin elevation include:
- Tachyarrhythmia
- Hypotension or hypertension
- Cardiac trauma
- Acute heart failure
- Myocarditis and pericarditis
- Acute pulmonary thromboembolic disease
- Severe noncardiac conditions such as sepsis, burns, and respiratory failure
- Drug toxicity, including cancer chemotherapy
- Renal failure
- Structural cardiac abnormalities, such as left ventricular hypertrophy or ventricular dilatation.
From the Research
Troponin Elevation
There are no research papers provided to assist in answering this question about Troponin (cardiac enzyme) elevation. The studies provided are related to Donepezil and its use in treating Alzheimer's disease, and do not mention Troponin or cardiac enzyme elevation.
- The studies 2, 3, 4, 5 discuss the efficacy and safety of Donepezil in patients with mild, moderate, or severe dementia due to Alzheimer's disease.
- Study 6 explores the neuroprotective effects of Donepezil in a rat model of ischaemic stroke, but does not mention Troponin or cardiac enzyme elevation.
- None of the studies provided contain information relevant to Troponin elevation, therefore, no further analysis can be conducted.