Troponin I (Beckman)

General Information

Lab Name

Troponin I (Beckman)

Lab Code

TROPBC

Description

Beckman Coulter High Sensitivity Troponin-I: Values of 15 ng/L for women and 20 ng/L for men are the 99th percentile values for a healthy population (from package insert).

Clinical Interpretation:

According to current consensus guidelines (Gulati, 2021; Sandoval, 2022), high sensitivity troponin concentrations exceeding the 99th percentile are suggestive of cardiac injury. Such injury can arise from various causes (see examples below).

For troponin concentrations greater than 50 ng/L (Beckman Coulter), the most likely underlying etiology is myocardial infarction (Mark, 2023; Byrne, 2023).

In women, troponin levels between 16–50 ng/L (Beckman Coulter), and in men, levels between 21–50 ng/L (Beckman Coulter), warrant serial measurements and correlation with clinical findings for accurate interpretation, in accordance with guideline recommendations (Gulati, 2021).

Partial list of non-ischemic causes of elevated troponin (myocardial damage)

• Heart Failure
• Pulmonary Embolism
• Chronic Kidney Disease
• Sepsis
• Chemotherapy-Associated Cardiac Toxicity
• Cardiotoxicity of Other Drugs
• Cocaine Use
• Infection and Myocarditis
• Myopericarditis
• Myocardial contusion

Frequently Asked Questions Regarding the Use of Troponin (Adapted from Newby, 2012, Table 3)

What does an elevated troponin level mean?

• Elevated troponin is a sensitive and specific indication of myocardial damage, with troponin release from myocytes into the systemic circulation.
• In and of itself, elevated troponin does not indicate myocardial infarction (myonecrosis due to ischemia); rather, it is nonspecific relative to the etiology of myocardial damage.
• Troponin elevation occurs in ischemia and many nonischemic clinical conditions (see above).

When should a troponin level be obtained?

• Because an elevated troponin concentration is not specific for myocardial infarction, troponin evaluation to rule out myocardial infarction should be performed only if clinically indicated.
• An elevated troponin level must always be interpreted in the context of the clinical presentation and pre-test likelihood that it represents myocardial infarction.
• Troponin is recommended for diagnosis of myocardial infarction in chronic kidney disease patients with symptoms of myocardial infarction (regardless of the severity of renal impairment). A rise or fall in troponin values of ≥20% over 6 to 9 h should be used to define acute myocardial infarction in end-stage renal disease patients, recognizing that troponin concentrations are higher in patients with renal insufficiency, even in the absence of infarction.

What is the prognostic significance of an elevated troponin level?

• Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.
• For patients with non-ST-segment elevation acute coronary syndrome, global risk assessment, rather than any single risk marker, best informs prognosis and is preferred to guide therapeutic decisions.

References

• Gulati M, et al. (2021) AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 144(22):e368-e454. doi: 10.1161/CIR.0000000000001029
• Sandoval Y, et al. (2022) High-Sensitivity Cardiac Troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guidelines for the Evaluation and Diagnosis of Acute Chest Pain. Circulation. 146(7):569-581 doi: 10.1161/CIRCULATIONAHA.122.059678
• Mark DG, et al. (2023) Diagnostic Performance of High-Sensitivity Cardiac Troponin I in a Multicenter U.S. Emergency Department Cohort. JACC: Advances 2(7):100558. doi: 10.1016/j.jacadv.2023.100558
• Byrne RA, et al. (2023) ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 44(38):3720–3826. doi: 10.1093/eurheartj/ehad191
• Newby LK, et al. (2012) ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 60(23):2427-63. doi: 10.1016/j.jacc.2012.08.969

Components