Troponins: established and novel indications in the management of cardiovascular disease

### Learning objectives ### Cardiac troponins Cardiac troponins (cTn) are components of the thin filament of the sarcomere of striated muscle regulating excitation–contraction coupling in the heart.1 2 Owing to their superior sensitivity and cardiac tissue specificity compared with cardiac enzymes or creatine kinase-MB mass, cardiac troponin T or I (cTn) are now considered the preferred biomarkers for the diagnosis of myocardial injury.3 4 Reasons for elevated cTn with or without kinetic changes are numerous and sometimes multifactorial while in some cases a reason cannot be identified despite intensive diagnostic work-up.4 Use of high-sensitivity (hs) troponin assays allow more accurate and earlier detection of myocardial infarction (MI).5–7 Higher analytical sensitivity increases the number of patients with analytically true positive cTn result due to non-ST-elevation MI but also due to numerous acute or chronic diseases in the absence of overt ischaemic heart disease. Use of hsTn has also enabled to determine a 99th percentile value of a healthy reference population and to demonstrate lower reference values for women than for men.5 8 For diagnosis, prognosis and management of acute coronary syndrome (ACS), cTn should—with few exceptions—be measured serially …