Сердечные тропонины: современное представление о клиническом и прогностическом значении в многопрофильном стационаре

Abstract

The increase of patients with elevated cardiac troponins in blood without signs of acute coronary syndrome in recent years, associated, among other reasons with the pandemic of coronavirus infection, has made differential diagnosis difficult for physicians of multidisciplinary hospitals. Aim of the study: to investigate the clinical and prognostic significance of elevated cardiac troponins associated with non-coronarogenic causes, including in the COVID-19 pandemic conditions. Materials and methods: a search of 57 literature sources from eLIBRARY, PubMed, Web of Science, Scopus, Google Scholar, and freely available Yandex and Google databases was performed. The results of the literature review showed that the use of highly sensitive cardiac troponins is relevant for clinical evaluation of the course and differential diagnosis of heart diseases (coronary and non-coronary) and other internal organs pathology, but the accuracy of the troponin test, combined with its nonspecificity, requires a cautious approach to the interpretation of the results. Also isolated elevation of cardiac troponins does not indicate the mechanism of myocardial damage and is not an indication for patients transfer to intensive care units or vascular centers. Routine use of troponin tests makes it difficult to make true diagnosis for patients in a multidisciplinary hospital. Many studies have shown that elevated troponin levels not associated with acute coronary syndrome have a negative prognostic value, but when the coronary event is excluded, elevated troponin levels should not be ignored; it is necessary to look for the cause of such changes. The integration of cardiac troponins in predicting the risk of occurrence, progression, and complications of various diseases is a promising area for further research.