Elevated cardiac troponin may occur without heart attack

May 9, 2017, American College of Cardiology

Elevated cardiac troponin, a diagnostic marker of damage to the heart, may occur even if a patient has not had a heart attack, according to a study published in JACC: Basic to Translational Science.

In a porcine model of brief ischemia leading to reversible stunning in the absence of myocardial tissue necrosis, Brian R. Weil, PhD, and colleagues demonstrated delayed release of cardiac troponin I that exceeded the 99th percentile for normal animals 60 minutes after reperfusion and rose to readily detectable levels 24 hours later. Although tissue analysis at 60 minutes showed no evidence of necrotic myocyte seen with a myocardial infarction, TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling) staining demonstrated isolated myocytes undergoing apoptosis, which was absent after 24 hours. These results demonstrate that cardiac troponin I elevations occur after cardiac injury that is not severe enough to produce classic myocyte necrosis that is observed following and that elevated troponin levels may reflect myocyte injury in the absence of pathological evidence of infarction.

"This study by Weil and colleagues, although performed in a large animal model, may have important implications for health care systems, which are currently overwhelmed with trying to understand how to choose the appropriate diagnostic codes for hospitalized patients who have elevated troponin levels, which are being detected with alarming regularity following the FDA approval of new 'high sensitivity' troponin assays," said Douglas L. Mann, MD, FACC, editor-in-chief of JACC: Basic to Translational Science. "A rise in troponin has traditionally been associated with an . Accordingly, when a patient has an elevated troponin level, they are often subjected to a battery of expensive non-invasive and invasive testing in order to be certain that the patient is not at risk of dying from a 'heart attack.'

"This study by Weil and colleagues clearly shows that troponin elevations can occur in the absence of a classic , but can occur from a different form of cell death, called apoptosis. Although the study may not immediately stop the unnecessary testing that follows the incidental detection of an elevated troponin level, it should focus future research efforts on understanding how and why troponin is released from the heart, so that we have a better understanding of what to say to when they have an elevated level detected on a routine laboratory test."

Explore further: Physical activity may ward off heart damage

More information: Brian R. Weil et al, Brief Myocardial Ischemia Produces Cardiac Troponin I Release and Focal Myocyte Apoptosis in the Absence of Pathological Infarction in Swine, JACC: Basic to Translational Science (2017). DOI: 10.1016/j.jacbts.2017.01.006

Related Stories

Physical activity may ward off heart damage

April 24, 2017
Physical activity can lower the risk of heart damage in middle-aged and older adults and reduce the levels of heart damage in people who are obese, according to research published today in JACC: Heart Failure.

A single high-sensitivity troponin T result could quickly and safely rule out MI in the ED

April 17, 2017
High-sensitivity assays for cardiac troponin T can quickly and safely rule out myocardial infarction (MI) in patients presenting to emergency departments (ED) with possible emergency acute coronary syndrome. A single troponin ...

Heart test changes could save lives

April 25, 2017
New advice for doctors could prevent almost 3000 heart attacks being missed each year, Edinburgh researchers say. They have called for the guidelines on using blood tests to diagnose heart attacks to be urgently implemented ...

Early invasive doesn't beat selective strategy in NSTE-ACS

April 17, 2017
(HealthDay)—An early invasive strategy has no benefit for reducing the 10-year composite outcomes of death or spontaneous myocardial infarction (MI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) ...

Blood test can detect heart damage after non-cardiac surgery

March 20, 2017
A blood test for a protein called high-sensitivity troponin T, which is released into the bloodstream when injury to the heart occurs, can identify patients with heart damage after non-cardiac surgery whose lives could potentially ...

Elevated biomarker following surgery linked to increased risk of death

April 25, 2017
Among patients undergoing noncardiac surgery, peak postoperative high-sensitivity troponin T measurements (proteins that are released when the heart muscle has been damaged) during the first three days after surgery were ...

Recommended for you

Stroke drug demonstrates safety in clinical trial

February 20, 2018
A preliminary Phase 2 clinical trial has demonstrated that patients with acute ischemic stroke, the most common type of stroke, can safely tolerate high doses of 3K3A-APC, a promising anti-stroke drug invented at The Scripps ...

Can your cardiac device be hacked?

February 20, 2018
Medical devices, including cardiovascular implantable electronic devices could be at risk for hacking. In a paper publishing online today in the Journal of the American College of Cardiology, the American College of Cardiology's ...

Women once considered low risk for heart disease show evidence of previous heart attack scars

February 20, 2018
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart ...

Number of obese years not—just obesity—a distinct risk factor for heart damage

February 20, 2018
In an analysis of clinical data collected on more than 9,000 people, Johns Hopkins researchers have shown that the number of years spent overweight or obese appear to "add up" to a distinct risk factor that makes those with ...

Heart attack symptoms often misinterpreted in younger women

February 20, 2018
Young women who report heart attack symptoms are more likely to have them dismissed by their providers as not heart related, a new study led by the Yale School of Public Health (YSPH) finds.

A drug long used to treat gout may help adult heart failure patients

February 20, 2018
Researchers at the University of Cincinnati (UC) College of Medicine have shown that probenecid, a drug long used to treat gout, may be able to improve heart function in adult patients who experience heart failure.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.