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High Sensitive Troponin T Assay


Laboratory medicine switched from the Troponin I assay to a highly sensitive Troponin T assay. This change coincided with the introduction of the new ACS pathway, and all information on that pathway refers to the new assay. The major changes were as follows:
  1. The assay measures Troponin T rather than Troponin I
  2. Reporting Units changed from micrograms per litre (ug/L) to nanograms per litre (ng/L)
  3. The cut-off for ACS which was 0.05 ug/L with the Troponin I assay has become 30 ng/L with the Troponin T assay
  4. Troponin T is the first routine Troponin assay to be able to detect Troponin in normal individuals, and so a lower cut-off will also be reported which is the 99th centile of the normal distribution and is 14 ng/L. Results between 14 and 30 ng/L are abnormal, but the clinical implications are less well established than for results > 30 ng/L. There are other causes of an elevated Troponin which should also be considered. See below.
  5. Because of the improved assay sensitivity, the timing of samples has changed. Samples should be taken on admission (or at the time of an event) and then repeated (if necessary " see ACS protocol) at 6 hours after the event or symptom onset. This is instead of the previous recomendation of 12 hours.

  Causes of elevated Troponin in the absence of overt ischaemic heart disease:

  • Congestive heart failure"acute and chronic
  • Pulmonary embolism, severe pulmonary hypertension
  • Rhabdomyolysis with cardiac injury
  • Inflammatory diseases, e.g. myocarditis or myocardial extension of endo-/ pericarditis
  • Infiltrative diseases, e.g. amyloidosis, haemochromatosis, sarcoidosis, and scleroderma
  • Critically ill patients, especially with respiratory failure or sepsis
  • Renal failure
  • Cardiac contusion, or other trauma including surgery, ablation, pacing, etc
  • Aortic dissection
  • Aortic valve disease
  • Hypertrophic cardiomyopathy
  • Tachy- or bradyarrhythmias, or heart block
  • Acute neurological disease, including stroke or subarachnoid haemorrhage
  • Apical ballooning syndrome
  • Drug toxicity or toxins
  • Burns, especially if affecting >30% of body surface area
  • Extreme exertion 


  • Thygesen K et al  Universal definition of myocardial infarction. Eur Heart J 2007;28:2525
  • Jaffe AS, Babuin L, Apple FS.Biomarkers in acute cardiac disease. J Am Coll Cardiol 2006;48:1"11
  • French JK, White HD.Clinical implications of the new definition of myocardial infarction. Heart 2004;90:99"106