Clinical Impact of Macrotroponin on Immunometric Troponin Assays: A Cross-Analytical Case Evaluation
Key result
Macrotroponin results in stable but misleadingly elevated cTnI levels without myocardial injury.
Why the study?
High-sensitivity cardiac troponin assays are vulnerable to macrotroponin analytical interference, which can lead to misdiagnosis, unnecessary testing, and inappropriate management.
Population
A 74-year-old woman with hypertension, intermittent mild chest discomfort, and exertional dyspnea
Comparison
Testing across different assay platforms and polyethylene-glycol (PEG) precipitation
Design
Case report
Follow-up
Several months
Authors
Discussion
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Implication
Orthogonal testing for macrotroponin warranted in unexplained troponin elevations; leaves open standardized detection protocols across assays.
Key Points
- This evaluation aims to clarify the influence of macrotroponin on high-sensitivity cardiac troponin assays.
- Case study of a 74-year-old woman with elevated cardiac troponin I concentrations.
- Assessment of clinical, electrocardiographic, and imaging evidence of myocardial injury.
- Use of orthogonal testing across different assay platforms.
- Application of polyethylene-glycol (PEG) precipitation to identify sources of interference.
- Persistently elevated troponin I levels were observed without evidence of myocardial injury.
- Different assay platforms showed discordant results related to elevations.
- PEG precipitation significantly reduced assay signals, confirming the presence of macrotroponin.
Structured PICO
P
Population
74-year-old woman with hypertension presenting with intermittent mild chest discomfort and exertional dyspnea
I
Intervention
Orthogonal testing across different assay platforms and polyethylene-glycol (PEG) precipitation
O
Outcome
Confirmation of macrotroponin as the source of assay-dependent analytical interference
Recognizing macrotroponin interference through orthogonal testing and PEG precipitation is crucial to avoid misdiagnosis and unnecessary procedures in patients with isolated troponin elevation.
Cite This Study
Salvatici et al. (2026) studied this question. Macrotroponin led to stable but misleadingly elevated cardiac troponin I levels in a 74-year-old woman without myocardial injury, highlighting diagnostic challenges.