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BEST PRACTICES :: UNDERSTANDING ELEVATED TROPONIN


may be from acute non-ischemic disease, or chronic disease that causes myocardial injury. The consideration for acute MI versus other cardiac or non-cardiac and systemic diseases, and communication with the laboratory if an analytical-related in- fluence is suspected, will help ensure the patient receives the most accurate diagnosis and treatment plan.


REFERENCES


1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myo- cardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264. doi:10.1016/j. jacc.2018.08.1038.


2. Sandoval Y, Apple FS, Mahler SA, et al. High-sensitivity cardiac troponin and the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guidelines for the evaluation and diagnosis of acute chest pain. Circulation. 2022;146(7):569-581. doi:10.1161/ circulationaha.122.059678.


3. Apple FS, Sandoval Y, Jaffe AS, Ordonez-Llanos J. Cardiac troponin assays: Guide to understanding analytical characteristics and their impact on clinical care. Clin Chem. 2017;63(1):73-81. doi:10.1373/clinchem.2016.255109.


4. Chaulin AM. False-positive causes in serum cardiac troponin levels. J Clin Med Res. 2022;14(2):80-87. doi:10.14740/jocmr4664.


5. du Fay de Lavallaz J, Prepoudis A, Wendebourg MJ, et al. Skeletal muscle dis- orders: A noncardiac source of cardiac troponin T. Circulation. 2022;145(24):1764- 1779. doi:10.1161/circulationaha.121.058489.


6. Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skel- etal muscle. J Am Coll Cardiol. 2011;58(17):1819-1824. doi:10.1016/j.jacc.2011.08.026.


7. Mueller C, Giannitsis E, Jaffe AS, et al. Cardiovascular biomarkers in patients with COVID-19. Eur Heart J Acute Cardiovasc Care. 2021;10:310-319. doi:10.1093/ ehjacc/zuab009.


8. Harley K, Bissonnette S, Inzitari R, et al. Independent and combined effects of biotin and hemolysis on high sensitivity cardiac troponin assays. Clin Chem Lab Med. 2021;59:1431–1443. doi:10.1515/cclm-2021-0124.


9. Kavsak PA, Edge T, Roy C, et al. Analytical assessment of ortho clinical diagnos- tics high sensitivity cardiac troponin I assay. Clin Chem Lab Med. 2020;59:749–755. doi:10.1515/cclm-2020-1115.


10. Wei J, Wu YN, Ling Y, Chen XT, Zhu Q, Xu J. False decrease of high-sensitivity cardiac troponin T assay in pneumatic tube system samples. Clin Chim Acta. 2019;495:507–511. doi:10.1016/j.cca.2019.05.027.


11. Santos LG, Carvalho RR, Sá FM, et al. Circulating Heterophile Antibodies Causing Cardiac Troponin Elevation. An Unusual Differential Diagnosis of Myo- cardial Disease. JACC Case Reps. 2020;2:456-460. doi:10.1016/j.jaccas.2020.01.011.


12. Lippi G, Aloe R, Meschi T, Borghi L, Cervellin G. Interference from heterophilic antibodies in troponin testing. Case report and systematic review of the literature. Clin Chim Acta. 2013;426:79–84. doi:10.1016/j.cca.2013.09.004.


13. Kavsak PA, Roy C, Malinowski P, et al. Macrocomplexes and discordant high-sensitivity cardiac troponin concentrations. Ann Clin Biochem. 2018;55:500- 504. doi:10.1177/0004563217734883.


14. Ghossein J, Ghossein J, Booth RA, Kavsak P, Chamoun C. Presence of Mac- rotroponin for Over 2 Years in a Young Woman. CJC Open. 2022;4:1012-1014. doi:10.1016/j.cjco.2022.07.016.


15. Warner JV and Marshall GA. High incidence of macrotroponin I with a high-sensitivity troponin I assay. Clin Chem Lab Med. 2016;54:1821-1829. doi:10.1515/ cclm-2015-1276.


16. Saunders A, Tsui AKY, Alhulaimi N. Persistent Troponin Elevation in the Setting of an Elevated Rheumatoid Factor: When It Pays to Double Check. CJC Open. 2021;3:981-983. doi:10.1016/j.cjco.2021.02.014.


17. Kazmierczak SC, Sekhon H, Richards C. False-positive troponin I measured with the Abbott AxSYM attributed to fibrin interference. Int J Cardiol. 2005;101:27-31. doi:10.1016/j.ijcard.2004.03.008.


18. Simons J, Beach L, Clark L, Kavsak PA. Matrix and bilirubin interference for high-sensitivity cardiac troponin I. Clin Chim Acta. 2015;442:49-51. doi:10.1016/j. cca.2015.01.002.


19. Klinkenberg LJ, van Dijk JW, Tan FE, van Loon LJ, van Dieijen-Visser MP, Meex SJ. Circulating cardiac troponin T exhibits a diurnal rhythm. J Am Coll Cardiol. 2014;63:1788–95. doi:10.1016/j.jacc.2014.01.040.


20. Paul HA, Chi Q, Gifford JL, Seiden-Long I. Not T too! False elevations in high-sensitivity cardiac troponin T (hs-cTnT) following specimen transport. Clin Biochem. 2023;115:86-91. doi:10.1016/j.clinbiochem.2022.08.008.


Kalen Nissen serves as a Senior Director of Medical Sciences and Medical Officer for Diagnostics at Siemens Healthineers. Before joining Siemens Healthineers, she served as the Clinical Laboratory Director at a large healthcare system in the Minneapolis/St. Paul metropolitan area.


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