Balancing New Knowledge and Common Sense
Balancing New Knowledge and Common Sense
A 2000 consensus document, updated in 2007 by the American College of Cardiology, American Heart Association and the European Society of Cardiology, redefined myocardial infarction (MI). Based on this definition, the measurement of cardiac troponins (cTn) became the new reference standard for diagnosing myocardial injury. The change evolved from strong evidence demonstrating that cTn (I or T) has nearly absolute myocardial tissue specificity, as well as high sensitivity, for reflecting even microscopic zones of myocardial necrosis (Slide 1).
(Enlarge Image)
The sensitivity of cTn is such that research has now demonstrated elevations of troponin in many patients with a large number of acute and chronic conditions or diseases (Slide 2). Consequently, the interpretation of elevated cTn may be challenging and the sheer number of patients with such elevations may cause much frustration for the practitioner receiving the report showing elevated troponin levels.
(Enlarge Image)
Should small elevations in troponin be ignored? According to the consensus document, "It is now clear that any amount of myocardial damage, as detected by cardiac troponins, implies an impaired clinical outcome for the patient (Slide 3). This is apparently true for individuals with spontaneous events, as well as for patients who undergo coronary artery interventions. A review of currently available data demonstrates no discernible threshold below which an elevated value for cardiac troponin would be deemed harmless. All elevated values are associated with a worsened prognosis."
(Enlarge Image)
A 2000 consensus document, updated in 2007 by the American College of Cardiology, American Heart Association and the European Society of Cardiology, redefined myocardial infarction (MI). Based on this definition, the measurement of cardiac troponins (cTn) became the new reference standard for diagnosing myocardial injury. The change evolved from strong evidence demonstrating that cTn (I or T) has nearly absolute myocardial tissue specificity, as well as high sensitivity, for reflecting even microscopic zones of myocardial necrosis (Slide 1).
(Enlarge Image)
The sensitivity of cTn is such that research has now demonstrated elevations of troponin in many patients with a large number of acute and chronic conditions or diseases (Slide 2). Consequently, the interpretation of elevated cTn may be challenging and the sheer number of patients with such elevations may cause much frustration for the practitioner receiving the report showing elevated troponin levels.
(Enlarge Image)
Should small elevations in troponin be ignored? According to the consensus document, "It is now clear that any amount of myocardial damage, as detected by cardiac troponins, implies an impaired clinical outcome for the patient (Slide 3). This is apparently true for individuals with spontaneous events, as well as for patients who undergo coronary artery interventions. A review of currently available data demonstrates no discernible threshold below which an elevated value for cardiac troponin would be deemed harmless. All elevated values are associated with a worsened prognosis."
(Enlarge Image)
Source...