Metabolism of cardiac troponins (literature review)

The review summarizes all recent data on the metabolism of cardiac troponin isoforms. The main mechanisms of troponin release from intact myocardium are described. These mechanisms ensure its baseline levels (less than the 99th percentile) in all healthy individuals. There are various fragments of troponin that circulate in the blood flow as a heterogeneous pool. Their circulation is related to various intracellular and extracellular proteases. In-depth understanding ofthese mechanisms is required to improve the diagnostic process. The article provides new insights into the evaluation of cardiac troponins in other human biological fluids: pericardial, cerebrospinal, amniotic, urine, and oral fluid. The measurements of saliva and urine levels of troponins seem to be promising alternative for non-invasive diagnosis. Recent circadian patterns of high-sensitive cardiac troponin T alterations are reported. These patterns should be taken into account while practicing fast diagnostic algorithms.