Troponin I and Troponin T (cardiac enzymes)

Cardiac Troponins

 Troponins are protein components of striated muscle. There are three

different troponins: troponin C, troponin T and troponin I. Troponins T and I
are only found in cardiac muscle
o Troponin T (1)

 84% sensitivity for myocardial infarction 8 hours after onset of

symptoms (1); 81% specificity (1)

 low specificity - 22% for unstable angina

 advantages

 highly sensitive for detecting myocardial ischaemia

 levels may help to stratify risk afterward

o Troponin I

 90% sensitivity for myocardial infarction 8 hours after onset of

symptoms (1); 95% specificity (1)

 low specificity for unstable angina - 36% - note however that

there is evidence that (2)

troponin I elevation is useful for predicting in-hospital risk for

unstable angina patients admitted to a community hospital. The
association of ECG changes and high troponin I identifies a
population at very high risk; however, the absence of both
variables in patients with a diagnosis of unstable angina does
not preclude the development of events

 rises after 3-6 hours (1)

 peaks at about 20 hours (1)

 general advantages (3)

o troponin T (cTnT) and troponin I (cTnI) are released only following

cardiac damage

 CK and CK-MB are found in skeletal muscle as well as cardiac

muscle - therefore if there is damage to skeletal muscle,
elevations of CK and CK-MB will occur and can make the
diagnosis of myocardial infarction difficult. In such a situation
levels of cTnT and/or cTnI will not rise unless myocardial
infarction has occurred

o troponin T and I are present for, and remain elevated, a long time

 unlike CK and CK-MB, cTnT and cTnI are released for much
longer with cTnI detectable in the blood for up to 5 days and
cTnT for 7-10 days following MI. This allows an MI to be
detected if the patient presents late. For example, if a patient
comes to the surgery with a history of chest pain 2-3 days ago,
measurement of cTnT or cTnI will allow the diagnosis or
exclusion of MI as a cause of the chest pain

o troponin T and I are very sensitive

there is always a low level release of CK and CK-MB from skeletal muscle at a low
level all the time so there is always a background value. This is not the case for the
cardiac structural proteins such as cTnT and cTnI and therefore, they are very
sensitive. Studies have revealed that about one third of patients admitted with
unstable angina, in whom MI was apparently excluded by CK and CK-MB
measurement, have raised levels of cTnT and cTnI. Follow up studies have revealed
that these patients are at significantly greater risk of death, subsequent MI or
readmission with unstable angina than patients who did nothave detectable levels
cTnT or cTnI

 general disadvantages (3)

o elevation of cTnT or TnI is absolutely indicative of cardiac damage, but
this can occur as a result of causes other than MI e.g. myocarditis,
coronary artery spasm from cocaine, severe cardiac failure,cardiac
trauma from surgery or road traffic accident, and pulmonary embolus
can cause cardiac damage with an accompanying elevation of cardiac
troponin(s)

o failure to show a rise in cTnT or cTnI does not exclude the diagnosis of
ischaemic heart disease

o both cTnT and cTnI may be elevated in patients with chronic renal
failure and indicate a higher long-term risk of death. They can be
distinguished from changes due to myocardial infarction by repeating
the tests. Myocardial infarction causes a rise and fall in cTnT or cTnI,
but in renal failure the elevated levels are sustained

o reference ranges may vary between laboratories and are dependent on

methods of measurement used

Reference:

1. Ebell MH et al (2000). A systematic review of troponin T and I for diagnosing

acute myocardial infarction. J Fam Pract, 49, 550-6.
2. Rev Esp Cardiol 2002 Feb;55(2):100-106 [Is Troponin I Useful for Predicting
In-Hospital Risk for Unstable Angina Patients in a Community Hospital?
Results of a Prospective Study. Bodi V V, Sanchis J, Llacer A, Graells ML,
Llorca L, Chorro FJ, Insa LD, Navarro A, Plancha E, Cortes FJ, Ponce De Leon
JC, Valls A

British Heart Foundation (Factfile 08/2003). What are cardiac troponins?

[Comparison of clinical performance of troponin T and troponin I
in diagnosing acute myocardial infarction].
[Article in Lithuanian]
Karciauskaite D, Grybauskiene R, Statkeviciene A, Auskalniene R.

Source
Institute of Cardiology, Kaunas University of Medicine, Sukileliu 17, 50157 Kaunas, Lithuania.
dovilek@yahoo.com

Abstract
In this article we investigate clinical specificity and sensitivity of cardiac troponin T and
cardiac troponin I tests in the patients who were admitted to the hospital with suspected
acute coronary syndrome. We investigated 87 patients: the clinical investigation was
performed, electrocardiogram was recorded and concentrations of cardiac troponin T
and troponin I were estimated. According to the recommendations of the manufacturers
of troponin T and troponin I tests, threshold diagnostic troponin T concentration for
myocardial infarction was considered > or =0.1 ng/ml and troponin I > or =1.0 ng/ml.
Troponin T concentration was analyzed in 60 patients; the sensitivity of troponin T test in
diagnosing acute myocardial infarction was 85%, and the specificity was 87.2%.
Troponin I test was performed in 46 patients; the sensitivity of the test was 76% and the
specificity was 76.2%. In case when both troponin T and I tests were performed, the
sensitivity of troponin T was 100% and specificity was 78% and of troponin I -
respectively 86% and 78%. According to the receiver operator characteristic analysis
there was no significant difference between the general accuracy of troponin T and
troponin I in distinguishing patients with and without acute myocardial infarction.
According to the results of receiver operator characteristic analysis, the biggest clinical
sensitivity and specificity were achieved when threshold myocardial infraction diagnostic
concentration of troponin T was considered >0.04 ng/ml and of troponin I >0.69 ng/ml.