Long cardiac troponin T in myocardial infarction: the SuperTROPO study is a promising starting point

This commentary refers to ‘Long forms of cardiac troponin T for myocardial infarction diagnosis: the SuperTROPO study’, by K. Teppo et al., https://doi.org/10.1093/eurheartj/ehaf975 and the discussion piece ‘Long cardiac troponin T in myocardial infarction: a promising diagnostic tool, a precision imperative’, by C. Meng et al., https://doi.org/10.1093/eurheartj/ehag327. We thank Meng et al. for their thoughtful comments on the SuperTROPO study. We agree that gaps remain in current evidence in translating long cardiac troponin T (cTnT) to clinical practice and welcome the opportunity to further contextualize our findings. First, regarding precision, we would like to emphasize that the long cTnT assay has been verified to meet the accepted analytical criteria for high-sensitivity (hs) troponin assays.1,2 Moreover, long cTnT provided incremental diagnostic information beyond conventional hs-cTnT, improving diagnostic accuracy for myocardial infarction (MI), particularly for type 1 MI. Second, although further research on distinct acute cardiac conditions is surely needed, we want to highlight that long cTnT has already been shown to demonstrate diagnostic ability in distinguishing hs-cTnT elevations caused by MI from those associated with Takotsubo syndrome, atrial fibrillation, strenuous exercise, and kidney disease.3–5 Likewise, in the SuperTROPO study, long cTnT appeared to perform well in distinguishing MI patients from non-MI patients across several subgroup analyses, indicating that it may improve diagnostic accuracy across a range of clinical scenarios.