McGrath Samuel, Alaour Bashir, Kampourakis Thomas, Marber Michael
King's BHF Centre of Research Excellence, King's College London, London, United Kingdom.
King's BHF Centre of Research Excellence, King's College London, London, United Kingdom.
JACC Adv. 2025 Mar 28;4(5):101695. doi: 10.1016/j.jacadv.2025.101695.
Cardiac troponin is the gold standard biomarker for the diagnosis of acute myocardial infarction (AMI). Development of high-sensitivity troponin platforms has revolutionized triage of chest pain patients, but specificity for type 1 AMI remains a clinical limitation. Consequently, differentiating type 1 AMI from other forms of myocardial injury is a common conundrum, heightened by the risks associated invasive coronary angiography. The troponin complex is a dynamic structure comprising of 3 subunits which variably fragment prior to measurement in the blood. Documenting the fragmentation patterns of cardiac troponin may help identify the cause of myocardial injury. This review explores the biology underlying troponin fragmentation and summarizes multiple lines of evidence that it can improve the specificity for diagnosis of type 1 AMI.
心肌肌钙蛋白是诊断急性心肌梗死（AMI）的金标准生物标志物。高灵敏度肌钙蛋白检测平台的发展彻底改变了胸痛患者的分诊方式，但对1型AMI的特异性仍然是一个临床局限性。因此，将1型AMI与其他形式的心肌损伤区分开来是一个常见的难题，而有创冠状动脉造影相关的风险加剧了这一难题。肌钙蛋白复合物是一种动态结构，由3个亚基组成，在血液中测量之前会发生不同程度的片段化。记录心肌肌钙蛋白的片段化模式可能有助于确定心肌损伤的原因。本综述探讨了肌钙蛋白片段化背后的生物学机制，并总结了多条证据，表明其可提高1型AMI诊断的特异性。
