Evaluating the intra-individual variability of high-sensitivity cardiac troponins over time is proposed for more accurate cardiovascular risk estimation and differential diagnosis of acute syndromes.
Understanding the analytical and intra-individual variability of high-sensitivity cardiac troponins is crucial for accurately diagnosing acute myocardial injury and estimating cardiovascular risk.
In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI and hs-cTnT variations is particularly relevant: a) for the differential diagnosis of Acute Coronary Syndromes (ACS) in patients admitted to the Emergency Department (ED); b) for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged >55 years and with co-morbidities; c) for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.
Clerico et al. (2023) conducted a review in Cardiovascular diseases and acute myocardial injury. High-sensitivity cardiac troponin (hs-cTnI and hs-cTnT) variation evaluation was evaluated. Evaluating the intra-individual variability of high-sensitivity cardiac troponins over time is proposed for more accurate cardiovascular risk estimation and differential diagnosis of acute syndromes.