Pathophysiology of Cardiac Troponin Release and Circulating Cardiac Troponin Forms – Potential Clinical Implications

Due to the high analytical sensitivity of current routine high-sensitivity cardiac troponin assays, unexpectedly elevated test results without an obvious clinical correlate are increasingly frequent in daily clinical practice. In these patients, myocardial injury may sometimes go undetected by imaging, including cardiac magnetic resonance imaging. This has led to an increased interest in the pathophysiology of cardiac troponin release, in particular on the fact, whether troponin can be released from reversibly injured myocardium and thereby resulting in an increase of cardiac troponin in the systemic circulation. On the other hand, a variety of circulating cardiac troponin forms were described in human blood samples using different analytical methods, raising the question whether the cause of myocardial injury can be reliably determined by measurement of specific circulating cardiac troponin forms. This review aims to provide an up-to-date overview of this current cardiac troponin research topics.