From the Guidelines
Troponin levels can indeed be elevated in individuals of advanced age due to various underlying cardiac conditions and decreased renal clearance. As people age, they often develop subclinical cardiac issues, such as chronic coronary syndromes (CCS) or hypertensive heart disease, which can lead to higher baseline troponin levels 1. According to the 2020 ESC guidelines for the management of acute coronary syndromes, many cardiac pathologies other than MI also result in cardiomyocyte injury and, therefore, cardiac troponin elevations 1.
Some key points to consider when interpreting troponin results in elderly patients include:
- Underlying conditions like left ventricular hypertrophy, coronary microvascular dysfunction, or reduced renal clearance of troponin can contribute to age-related elevation of troponin levels
- Clinicians should consider these age-related changes and look for significant changes from baseline rather than focusing solely on absolute values
- Significant increases in troponin levels should never be dismissed as merely age-related, as they may still indicate acute cardiac events requiring intervention
- Serial measurements and clinical correlation remain essential for proper diagnosis in elderly patients with elevated troponin levels
It's also important to note that, as stated in the 2020 ESC guidelines, elevations in cardiac troponin in elderly patients with renal dysfunction should not be primarily attributed to impaired clearance and considered harmless 1. Instead, cardiac conditions such as CCS or hypertensive heart disease seem to be the most important contributor to cardiac troponin elevation in this setting. Therefore, a comprehensive clinical evaluation is necessary to determine the cause of elevated troponin levels in elderly patients.
From the Research
Troponin Levels in Advanced Age
- Troponin levels can be elevated in individuals of advanced age due to various cardiac and non-cardiac conditions 2, 3, 4.
- A study found that older patients with troponin level elevation without an obstructive culprit lesion experienced a higher incidence of major adverse cardiovascular events during hospitalization compared to younger groups 4.
- Another study reported that cardiovascular mortality was higher among older patients compared to younger patients at an 11-year follow-up 4.
- Elevated troponin levels can be caused by etiologies other than acute coronary syndromes, and the causes of troponin elevation can vary with age 3, 5, 4.
- In patients with elevated troponin levels, the presence of chest pain, tobacco smoking, and wall motion abnormalities on echocardiogram were associated with an increased risk of true acute coronary syndrome (ACS) 6.
Causes of Troponin Elevation
- Troponin elevation can be caused by cardiac conditions such as heart failure, dysrhythmia, and dissection, as well as non-cardiac conditions like pulmonary embolism, sepsis, and stroke 2.
- A study found that the most frequent subgroups in the non-ACS group were non-ACS cardiovascular, infectious, renal, or hypertensive causes 3.
- Another study reported that the causes of troponin elevation in young patients included myocardial infarction, central nervous system pathologies, nonischemic cardiomyopathies, and end-stage renal disease 5.
Clinical Implications
- Clinicians should consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in their assessment of patients with troponin elevation 2.
- The diagnosis of ACS should not be solely based on elevated troponin levels, as it can lead to expensive workup and utilization of hospital resources 6.
- A comprehensive evaluation of patients with elevated troponin levels is necessary to determine the underlying cause and provide appropriate treatment 2, 3, 4, 6.