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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(2):62-66; doi:10.1093/bjaceaccp/mkn001
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cardiac troponins: their use and relevance in anaesthesia and critical care medicine

Juliet A. Wolfe Barry, BSc FRCA, Julian H. Barth, MD FRCP FRCPath and Simon J. Howell, FRCA MD
Specialist Registrar Anaesthesia
Consultant in Chemical Pathology & Metabolic Medicine
Leeds General Infirmary
Great George Street
Leeds LS1 3EX, UK
Tel: +44 0113-392-6360 E-mail: s.howell@leeds.ac.uk

Key Words: Cardiac troponins reflect myocardial damage but do not indicate its mechanism. In the absence of other evidence of ischaemia, another cause should be sought • cTn is currently the biomarker of choice in the diagnosis of acute MI. • Commercial assays for cTn are improving; however, there are still limitations because of the lack of international standardization. • No standard diagnostic criteria for perioperative MI exist and the role of postoperative cTn surveillance remains unclear. • Not all cTn release is in the setting of coronary artery disease. • Whatever the clinical setting, cTn elevation has prognostic significance

The first 150 words of the full text of this article appear below.

Cardiac markers were first recommended as part of diagnostic criteria for myocardial infarction (MI) by the World Health Organization in 1979.1 The cardiac troponins (cTn) have become the preferred biochemical markers (or biomarkers) of cardiac injury as they are more cardiac-specific than the MB fraction of creatine kinase (CK-MB) and have a very high sensitivity, detecting even microscopic areas of myocardial necrosis.


   Cardiac muscle and troponin
 
The contractile complex in cardiac muscle contains the contractile proteins actin and myosin, and the regulatory proteins troponins and tropomyosin. Troponin is necessary for the calcium mediated regulation of skeletal and cardiac muscle contraction. The troponin complex is a heteromeric protein located with tropomyosin on the actin filament. It consists of three single chain polypeptides: troponin T (cTnT), which binds the other troponin components to tropomyosin; troponin I (cTnI), which inhibits ATP activity when bound to actin; and troponin C (cTnc), which contains binding sites for calcium. Most . . . [Full Text of this Article]


   Troponin as a biomarker
 

   Troponin assays
 

   Acute coronary syndromes
 

   Perioperative setting
 

   Critical care setting
 

   Raised troponin in absence of acute MI
 
Demand ischaemia

Myocardial ischaemia

Direct myocardial cell injury

Myocardial strain

Chronic renal insufficiency


   Further Reading
 

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