Cardiac troponins: mechanisms of release and new options for diagnosis and prognosis of cardiovascular disease (literature review)

The modern high-sensitivity methods for cardiac troponin measurement make it possible to determine their concentration in the majority of individuals in the population, which makes it possible to detect subclinical myocardial damage. Current data on the molecular mechanisms of troponin release explain the associations between troponin levels and the development of adverse cardiovascular events in both asymptomatic individuals and patients with cardiovascular disease. Aim: To summarize the available data on laboratory methods for determining cardiac troponins and the mechanisms of their release, as well as the opportunities to use them for the diagnosis and prognosis of cardiovascular diseases in various clinical situations. Existing problems in the field of methodology for determining these biomarkers and possible ways to solve them are discussed. This article also addresses the issues of restratification of cardiovascular risk in the general population using cardiac troponins, as well as the use of these markers in groups of patients with a history of cardiovascular disease (patients with coronary heart disease, stroke, chronic heart failure). The use of troponins in these patients may help to individualize primary and secondary prevention. The review demonstrates that cardiac troponins are currently one of the most promising biomarkers of cardiovascular diseases, since they have high reproducibility and specificity, and their determination can influence the management of patients in a wide range of clinical situations.