TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: TRPS    
Troponin T, 5th Generation, Plasma

Useful For Suggests clinical disorders or settings where the test may be helpful

Aiding in the exclusion of the diagnosis of acute coronary syndrome in a single plasma specimen

 

Aiding in the diagnosis of acute coronary syndrome

 

Monitoring acute coronary syndromes and estimating prognosis

 

Possible utility in monitoring patients with nonischemic causes of cardiac injury

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Troponin T is a myofibrillar protein found in striated musculature. There are 2 types of myofilament: a thick filament containing myosin and a thin filament consisting of 3 different proteins, namely actin, tropomyosin, and troponin. Troponin is itself a complex of 3 protein subunits, which are termed troponin T, troponin I, and troponin C:

-Troponin T binds the troponin complex to tropomyosin

-Troponin I inhibits actomyosin ATPase in relation to the calcium concentration

-Troponin C has 4 binding sites for calcium and mediates calcium dependency

 

Troponin T is found in free cytosol and structurally bound protein. The unbound pool of troponin T is the source of early protein release in myocardial damage. Troponin T is released from the structural elements at a later stage, corresponding to the degradation of myofibrils that occurs in irreversible myocardial damage. Troponin T becomes elevated 2 to 4 hours after the onset of myocardial necrosis and can remain elevated for up to 14 days, or even longer on occasion.

 

The most common cause of cardiac injury is myocardial ischemia, ie, acute myocardial infarction. These patients are known to have an adverse short- and long-term prognosis compared to patients with unstable angina and no elevation of troponin T. Many of these patients, especially those with troponin T elevations above 30 ng/L, benefit from an aggressive strategy with anticoagulation and an invasive interventional strategy.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Males: < or =15 ng/L

Females: < or =10 ng/L

Interpretation Provides information to assist in interpretation of the test results

Values for healthy adults, based upon available literature and clinical guidelines, are 10 ng/L or less for women and 15 ng/L or less for men.

 

For patients who present with suspected acute coronary syndromes, troponin T values greater than the reference interval with a rising (> or =10 ng/L over 2 hours or > or =12 ng/L over 6 hours) pattern are highly suggestive of acute cardiac injury. Decreasing values are indicative of recent cardiac injury. Serial measurement is highly recommended for the diagnosis or exclusion of acute coronary syndromes.

 

Troponin T values greater than the reference interval are associated with adverse events in patients with ischemic heart disease and many other clinical situations. Clinical judgment is necessary to distinguish patients who have ischemic heart disease from those who do not.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

As with all markers of cardiac injury, elevations of cardiac troponin T (cTnT) do not in and of themselves indicate the presence of an ischemic mechanism. Many other disease states can be associated with elevations of cTnT via mechanisms different from those that cause injury in patients with acute coronary syndromes. These include: trauma including contusion, ablation, pacing; congestive heart failure; pulmonary embolism; renal failure; and myocarditis.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Sandoval Y, Jaffe AS: Using High-Sensitivity Cardiac Troponin T for Acute Cardiac Care. Am J Med 2017 Dec;130(12):1358-1365

2. Reichlin T, Cullen L, Parsonage WA, et al: Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Am J Med 2015 Apr;128(4):369-379

3. Gunsolus IL, Jaffe AS, Sexter A, et al: Sex-specific 99th percentiles derived from the AACC Universal Sample Bank for the Roche Gen 5 cTnT assay: Comorbidities and statistical methods influence derivation of reference limits. Clin Biochem 2017 Dec;50(18):1073-1077