Highly Sensitive Cardiac Troponin Assays: A Comprehensive Review of Their Clinical Utility

Cardiovascular disease is a major source of morbidity and remains the leading cause of death in the United States. To evaluate patients with suspected cardiovascular disease, several laboratory markers of cardiac injury are available including creatinine kinase, creatinine kinase isoenzyme MB, myoglobin, and cardiac troponins (cTn) I and T. cTns have become the preferred marker of cardiac damage because they are highly sensitive and are almost completely cardiac specific. Recently, highly sensitive cTn (hs-cTn) assays were developed and have been used across the world to more quickly and accurately diagnose myocardial infarction. In the United States, these assays have not been U.S. Food and Drug Association approved for clinical practice and therefore are only being used for research purposes. Advancements have taken place over the years in diagnosing and treating cardiovascular disease, but predicting who will suffer future cardiovascular events still remains elusive. A comprehensive review of the literature was conducted to discover how new hs-cTn are being utilized throughout other parts of the world and what potential future use they may serve here in the United States. Major subject points discussed in this article include the prevalence of detectable troponins in the general population, the use of hs-cTn assays in diagnosing a myocardial infarction, determining prognosis in patients who have experienced an acute coronary syndrome and in patients with congestive heart failure, predicting future risk of cardiovascular events in patients with coronary heart disease, and its potential role as a screening tool in primary prevention. The implementation of hs-cTn testing in the United States may be very beneficial to patients; however, more research will need to be done to fully elucidate the potential use of hs-cTn in clinical practice.