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Societies release first consensus statement on troponin testing
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Troponin testing has proved valuable in the diagnosis of MI, but elevated troponin levels can also be indicative of HF, trauma, kidney disease and pulmonary embolism. Therefore, placing the test in clinical context is essential, according to the first expert consensus document issued by the American College of Cardiology Foundation.
“There are many things that can cause damage to the heart muscle that would allow troponin to leak in the circulation where we can measure it, and it’s not always due to heart attack. So if we are indiscriminate in how we order these tests or we aren’t paying attention to the clinical scenario before us, we may miss something important,” L. Kristin Newby, MD, MHS, a Cardiology Today Editorial Board member and co-chair of the writing committee for the consensus statement, said in a press release.
L. Kristin Newby
The ACCF, in conjunction with the American Association for Clinical Chemistry, the American College of Chest Physicians, the American College of Emergency Physicians, the American Heart Association and the Society for Cardiovascular Angiography and Interventions, developed the consensus statement to provide a framework for clinicians to interpret the results of troponin testing in a useful mechanism-based construct, the writing committee said. In particular, the committee addresses the use of troponin in ACS, PCI and CABG, and non-ischemic conditions, such as HF, pulmonary embolism, chronic kidney disease, sepsis and chemotherapy-induced cardiomyopathy.
“From a clinician’s perspective, the first priority is to understand when (and why) to order (or not order) a troponin test. The best value of troponin testing remains in the diagnosis of MI. Therefore, in the setting of symptoms suggestive of ischemia and a nondiagnostic ECG, serial troponin testing is invaluable and has high sensitivity and specificity, especially when temporal changes in troponin level are considered. Even in the setting of MI, it is important to understand the clinical context as treatment may vary considerably (eg, between Type 1 and Type 2 MI). Therefore, it is crucial that the correct assignment is made according to the 2012 Universal Definition of Myocardial Infarction and that the patient is treated accordingly,” the document states.
“We need to be thinking about why we are ordering the troponin test before we order it,” Newby, also of the Duke University Medical Center, said. “We hope this document provides a road map to help clinicians be more deliberate when ordering these tests and interpreting the results.”
For more information:
Newby LK. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.08.969.
Disclosure: Disclosure information for the ACCF Board of Trustees, the board of the convening organization of this document, is available at http://www.cardiosource.org/ACC/About-ACC/ Leadership/Officers-and-Trustees.aspx. ACCF board members with relevant relationships with industry to the document may review and comment on the document but may not vote on approval.