What can elevate high-sensitivity (hs) troponin levels?

From the Guidelines

High-sensitivity troponin levels can be elevated by various cardiac and non-cardiac conditions, including tachyarrhythmias, heart failure, hypertensive emergencies, critical illness, myocarditis, and valvular heart disease, as stated in the 2021 ESC guidelines 1.

Conditions Elevating hs-Troponin

These conditions can cause cardiomyocyte injury, leading to the release of troponin into the bloodstream.

• Cardiac causes:
  • Stable coronary artery disease
  • Heart failure
  • Myocarditis
  • Pericarditis
  • Cardiac contusion from trauma
  • Cardiac procedures
  • Arrhythmias
• Non-cardiac causes:
  • Pulmonary embolism
  • Sepsis
  • Renal failure
  • Stroke
  • Critical illness
  • Strenuous exercise
  • Certain medications like chemotherapeutic agents (particularly anthracyclines)

Clinical Context and Interpretation

When interpreting elevated hs-troponin results, it's essential to consider the clinical context and look for a rising or falling pattern, as this is more specific for acute myocardial injury than a single elevated value 1. The mechanism behind troponin elevation involves damage to cardiac myocytes, which releases troponin into the bloodstream. In acute myocardial infarction, this occurs due to ischemic injury, but in other conditions, it may result from increased cardiac wall stress, direct myocyte toxicity, or altered cell membrane permeability. Advanced age and female sex can also affect baseline troponin levels 1. In most patients with renal dysfunction, elevations in cardiac troponin should not be primarily attributed to impaired clearance and considered harmless, as cardiac conditions such as chronic coronary or hypertensive heart disease seem to be the most important contributor to troponin elevation in this setting 1.

From the Research

Conditions that Elevate High-Sensitivity (hs) Troponin Levels

• Cardiac conditions:
  • Myocarditis 2, 3, 4, 5
  • Heart failure 3, 4, 6, 5
  • Pulmonary embolism 2, 3, 4, 6, 5
  • Cardiomyopathy 2
  • Dysrhythmia 3
  • Dissection 3
  • Acute perimyocarditis 4
  • Tako-tsubo 4
  • Tachycardia 4
• Non-cardiac conditions:
  • Sepsis 3, 4, 5
  • Stroke 3, 4, 5
  • Renal failure 6, 5
  • Rhabdomyolysis 5
  • Septic shock 5
  • Myopericarditis 5
  • Acute heart failure 2, 3
  • Severe coronary artery disease (CAD) 2

Clinical Considerations

• Elevated troponin levels can be caused by various conditions, and it is essential to consider the clinical context, patient symptoms, electrocardiogram, and ultrasound in the assessment of the patient with troponin elevation 3.
• Troponin elevation is a reflection of myocardial injury, and many conditions associated with critical illness may result in troponin elevation 3.
• The causes of troponin elevation include cardiac and non-cardiac conditions, and clinicians must consider the clinical context and other factors to avoid an inappropriate diagnosis of occlusion myocardial infarction (OMI) 3.