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The causes of increased troponin T
Last reviewed: 20.11.2021
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The concentration of troponin T increases after the onset of myocardial infarction significantly more than the activity of CC and LDH. In some patients with successful recanalization, the concentration of troponin T can increase by more than 300 times. The concentration of troponin T in the blood depends on the size of myocardial infarction. Thus, with large-focal or transmural myocardial infarction after thrombolysis, the concentration of troponin T can be increased up to 400 times, and in patients with myocardial infarction without Q-wave - only 37 times. The time to maintain a high concentration of troponin T in serum is also significantly longer than CC and LDH. The long period of release of troponin T into the blood increases the likelihood that the positive result of its determination was correct, especially in the subacute phase of myocardial infarction. "Diagnostic window" (the time during which the altered values of the studied index are revealed in pathological conditions) for troponin T is more than 4 times as compared with the CC and 2 times compared with LDH. The interval of absolute diagnostic sensitivity in acute myocardial infarction for troponin T is 125-129 h, for CK and LDH - 22 and 70 h respectively.
The concentration of troponin T in the serum increases in patients after heart operations. When heart transplantation, the concentration of troponin T increases to 3-5 ng / ml and remains at an elevated level of 70-90 days.
Non-coronary diseases and heart muscle lesions (myocarditis, cardiac trauma, cardioversion) may also be accompanied by an increase in the concentration of troponin T in the blood, but the dynamics of its change, characteristic of myocardial infarction, is absent.
The content of troponin T in serum can be increased with septic shock and chemotherapy due to toxic damage to the myocardium.
False positive results in the determination of troponin T in the blood serum can be obtained in the presence of hemolysis (interference), in patients with a significant increase in Ig concentration in the blood, acute renal failure and especially chronic renal failure, as well as in chronic muscle pathology.
An increase in the concentration of troponin T is possible with acute alcohol intoxication, but with chronic intoxication this is not observed.
Slightly elevated troponin T in serum is found in 15% of patients with severe skeletal muscle damage (KK-MB activity increases in 50% of these patients), so troponin T can be considered a highly specific marker of MI even with skeletal muscle damage.
Unlike the cardiac muscle, muscle T. T. Is expressed in skeletal muscle. Although specific monoclonal antibodies are used to determine cardiac troponin T, cross-reactive reactions occur when large amounts of troponin T enter from the skeletal muscle.
In patients with a troponin concentration of 0.1-0.2 ng / ml, the risk of early complications is particularly high, so in such cases active therapy and careful monitoring in dynamics is necessary. Since only a quantitative method for the determination of troponin T makes it possible to measure the concentration in the range 0.1-0.2 ng / ml, this study has the advantage over a fast qualitative method whose sensitivity threshold is 0.2 ng / ml.