Challenges regarding Troponin

This is the last update in 2012, but I am happy to end this year with one of the most challenging topics in medicine. The article is from J Am Coll Cardiol in Dec. You can find the Full text link here
1. Remeber: Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.

2. Elevated troponin is a sensitive and specific indication of cardiac myonecrosis, with troponin release from myocytes into the systemic circulation, but Troponin elevation occurs in many nonischemic clinical conditions such as:

a. Hypoxemia
b. right ventricular (RV) pressure overload following a PE
c. heart failure
d. CKD,
e. sepsis
f. thermal injury
g. blunt cardiac trauma
h. SAH
and you know about endocarditis, chronic lung diseases and … 

3. we discussed this before: the role of CAD (MI) and ESRD and Troponin, but again: Dynamic changes in troponin values of ≥20% over 6 to 9 h should be used to define acute MI in ESRD patients.

Very , Very Very Important:

4. “In the large, multicenter ADHERE (Acute Decompensated Heart Failure Registry) National database, 81% of patients admitted with heart failure had troponin testing, and nearly 6.2% of patients had abnormal troponin test results (troponin I ≥1.0 μg/l or troponin T ≥0.1 μg/l) after excluding patients with serum creatinine >2.0 mg/dl . Hospital mortality among troponin-positive patients was 8.0%, compared with 2.7% among troponin-negative patients (adjusted odds ratio [OR]: 2.55) and was independent of an etiology of heart failure (ischemic or nonischemic)”.

Our job is not to risk stratify Patient  with Heart Failue in ED with high troponin

 

Link To Full Text