Lippi Giuseppe, Lavie Carl J, Sanchis-Gomar Fabian
Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy.
Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA.
Clin Chem Lab Med. 2025 May 5. doi: 10.1515/cclm-2025-0418.
Cardiac injury, encompassing a spectrum of heart muscle damage, requires prompt and accurate diagnosis to improve patient outcomes. Early detection using cardiac biomarkers is vital for timely intervention and reducing mortality. This review highlights the role of high-sensitivity cardiac troponins (hs-cTns) in diagnosing cardiac injury. This article offers an overview of cardiac injury, including its causes, diagnostic challenges, and the evolution of biomarkers, up to the development and commercialization of "high-sensitivity" (hs-) cTns. The molecular structure of cardiac isoforms cTnI and cTnT, release kinetics, guidelines incorporation, diagnostic performance, and clinical application will be analyzed. It is concluded that the advent of hs-cTn assays has further expanded diagnostic capabilities by enabling the detection of low-level cTn elevations, which were previously undetectable using conventional methods. This enhanced sensitivity allows earlier identification of even minor cardiac injuries, facilitating prompt intervention and improving patient outcomes. However, this increased sensitivity also introduces interpretive challenges in understanding the nature of cardiac involvement, especially in distinguishing mild cTn elevations that may signify non-ischemic cardiac injury or be associated with other non-cardiac conditions.
心脏损伤包括一系列心肌损害，需要及时准确的诊断以改善患者预后。使用心脏生物标志物进行早期检测对于及时干预和降低死亡率至关重要。本综述强调了高敏心肌肌钙蛋白（hs-cTn）在诊断心脏损伤中的作用。本文概述了心脏损伤，包括其病因、诊断挑战以及生物标志物的演变，直至“高敏”（hs-）cTn的开发和商业化。将分析心肌同工型cTnI和cTnT的分子结构、释放动力学、指南纳入情况、诊断性能及临床应用。结论是，hs-cTn检测的出现通过能够检测到以前使用传统方法无法检测到的低水平cTn升高，进一步扩大了诊断能力。这种提高的敏感性使得即使是轻微的心脏损伤也能更早被识别，便于及时干预并改善患者预后。然而，这种增加的敏感性在理解心脏受累的性质方面也带来了解释性挑战，尤其是在区分可能表示非缺血性心脏损伤或与其他非心脏疾病相关的轻度cTn升高方面。
