Prognostic Significance and Pathophysiological Mechanisms of Increasing the Levels of Cardiospecific Troponins in Biological Fluids in Arterial Hypertension (Literature Review)

Abstract

Improved laboratory methods for the determination of cardiac troponins (cTnT and cTnI) with increased sensitivity (hs-cTnT and hs-cTnI), recently introduced into clinical practice, have opened up a number of new promising areas for research with the aim of further expanding diagnostic capabilities for the subsequent use of hs-cTnT and hs-cTnI in modern clinical practice. It has been shown that with the use of the highly sensitive methods, even the most insignificant and reversible damage to cardiomyocytes (for example, during physical exertion, psychoemotional stress, and other conditions) is accompanied by diagnostically significant increases in hs-cTnT and hs-cTnI levels. The introduction of highly sensitive immunoassays also changed a number of ideas about the biology of cardiac troponins, for example, they are no longer considered strictly intracellular molecules, since they are determined in all healthy patients and, accordingly, they can be considered as products of normal metabolism of cardiomyocytes when they appear in blood serum in small concentrations (less than 99 percentile). In addition to the accelerated acute myocardial infarction diagnosis, hs-cTnT and hs-cTnI have a high predictive value in a number of pathological conditions that cause non-ischemic cardiomyocytes damage. Currently, the possibility of using hs-Tn in the early stages of pathogenesis of cardiovascular disease or in patients with certain risk factors (for example, arterial hypertension) to assess the risk of possible short-term and long-term adverse cardiovascular events draws an enormous interest. The purpose of this article is to analyze the prognostic significance of highly sensitive cardiospecific troponins in patients suffering from arterial hypertension, to summarize and discuss possible pathophysiological mechanisms of cardiomyocyte damage and increased levels of hs-cTnT and hs-cTnI in these patients.