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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough the ability to measure cardiac troponin quickly and accurately has improved the cardiologist\u0027s ability to detect myocardial injury in the setting of acute coronary syndrome, there are a variety of noncoronary cardiac conditions that also lead to elevated troponin concentrations.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Joint European Society of Cardiology\/American College of Cardiology (ESC\/ACC) Committee\u0027s 2007 consensus document for the redefinition of myocardial infarction (MI) places significant emphasis on the detection of troponin T and troponin I [Thygessen. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2007]. Although the ability to measure cardiac troponin quickly and accurately has improved the cardiologist\u0027s ability to detect myocardial injury in the setting of acute coronary syndrome (ACS), there are a variety of noncoronary cardiac conditions that also lead to elevated troponin concentrations. Christian W. Hamm, MD, Kerckhoff Klinik, Bad Nauheim, Germany, discussed the implications of elevated troponin concentration in patients with noncoronary cardiopulmonary conditions, such as myocarditis, congestive heart failure, pulmonary embolism, and septic shock and in critically ill patients in whom there is myocardial necrosis but not necessarily ST or non-ST elevation myocardial infarction.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAn elevated troponin concentration is relatively common in critically ill patients and is strongly predictive of adverse outcomes. Compared with patients who have ACS, critically ill patients without ACS but with an elevated troponin concentration have poorer outcomes [Alcalai R et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2007]. In patients with congestive heart failure, an elevated troponin concentration is correlated with the severity of symptoms and is more frequently detected in patients with NYHA class III or IV compared with class II symptoms (p=0.02). Patients with severe heart failure and elevated troponin have significantly worse outcomes than similar patients with no troponin elevation [Setsuta K et al. \u003Cem\u003EAm J Med\u003C\/em\u003E 2002]. Similar findings have been reported for patients with myocarditis [Smith SC et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1997]. Troponin may also improve risk stratification in pulmonary embolism, as in-hospital death, prolonged hypotension, cardiogenic shock, and the need for resuscitation have been associated with elevated troponin concentration [Giannitsis E et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2000].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ELow-level troponin elevations have been observed in patients with chronic renal failure. However, in this setting, the elevation is generally characterized not by a rise and fall (which is typical with ACS) but a constant elevation. Outcomes have been associated with the degree of elevation in this population, with a greater-than-7-fold increase in mortality risk when concentrations of cardiac troponin T reach levels \u0026gt;0.10 ng\/mL [Dierkes J et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2000]. This prognostic ability of troponin T is retained, regardless of the creatinine clearance level, an indicator of kidney function [Aviles RJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EImprovements in the analytical performance of current-generation troponin assays have led to better prognostic assessment. The fourth- and fifth-generation assays are now 10 to 15 times more sensitive and are capable of detecting troponin within the first 2 hours of symptom onset in 90% of patients with MI compared with 61% of patients, using the older standard assays (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Weber M et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2011]. The ESC\/ACC Consensus Document states the troponin assay performance must be in the 99\u003Csup\u003Eth\u003C\/sup\u003E percentile of the reference control group and have a coefficient of variation \u226410% [Alpert JS. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2000]. There are four assays, two each for troponin T and I, that satisfy this requirement.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022High-Sensitivity Assay Troponin T in AMI.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-765758292\u0022 data-figure-caption=\u0022High-Sensitivity Assay Troponin T in AMI.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/34\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/34\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/34\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12459\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EHigh-Sensitivity Assay Troponin T in AMI.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EhsTnT = high-sensitivity assay for troponin T; TnT = standard assay for troponin T; \u201cReprinted from the \u003Cem\u003EAmerican Heart Journal\u003C\/em\u003E, Weber M et al, Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. July 2011;162(1):81\u201388, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003ECardiac troponin remains the preferred biomarker of myocardial injury and a central component in the diagnosis of myocardial infarction. Troponin, even at low-level elevations, remains one of the most powerful prognostic biomarkers across a variety of clinical settings. Analytical improvements in assay performance, however, have enabled the detection of myocardial injury at very low levels and in an increasing number of patients with diagnoses other than ACS. The increased frequency of detection and the decreased specificity for ACS have presented a challenge for clinicians. Consideration of the specific clinical context is critical in interpreting the significance of an elevated troponin concentration and understanding the therapeutic implications.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/10\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmz8d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmz8d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}