False-positive cardiac troponin elevations in skeletal muscle disease: Clinical relevance, mechanisms, and laboratory approaches

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00669806%3A_____%2F25%3A10504806" target="_blank" >RIV/00669806:_____/25:10504806 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11140/25:10504806

Výsledek na webu

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=mFAgRTt63Q" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=mFAgRTt63Q</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.33549/physiolres.935683" target="_blank" >10.33549/physiolres.935683</a>

Jazyk výsledku

angličtina

Název v původním jazyce

False-positive cardiac troponin elevations in skeletal muscle disease: Clinical relevance, mechanisms, and laboratory approaches

Popis výsledku v původním jazyce

Cardiac troponins are indispensable biomarkers for the diagnosis of acute myocardial infarction, but false-positive elevations that contradict the clinical picture remain a significant challenge in laboratory medicine. Analytical interferences may arise from macrotroponins, heterophile or anti-troponin antibodies, and the limited cardiac specificity of high-sensitivity troponin T (hs-cTnT) in skeletal muscle disease. Recent studies show that hs-cTnT is elevated in up to two-thirds of patients with myopathies, while high-sensitivity troponin I (hs-cTnI) is largely unaffected, underscoring the diagnostic advantage of hs-cTnI in this setting. A pragmatic diagnostic approach should combine clinical plausibility with stepwise laboratory testing. First, preanalytical factors such as sample mislabeling, fibrin clots, or hemolysis must be excluded and the measurement repeated. If the results remain incongruent, an alternative assay - ideally hs-cTnI - should be performed. Further evaluation may include heterophile-blocking reagents, polyethylene glycol precipitation to screen for macro-analytes, and, where available, confirmatory techniques such as gel filtration chromatography or immunoglobulin depletion (protein A/G). Although these strategies can help identify assay interference, there is no universally accepted gold standard. Awareness of false-positive elevations, careful interpretation of discordant troponin results, and effective collaboration between laboratories and clinicians are essential to prevent misdiagnosis and unnecessary interventions. Clear documentation of confirmed interferences further ensures safe patient management and provides guidance on which assays are reliable for future tests.

Název v anglickém jazyce

False-positive cardiac troponin elevations in skeletal muscle disease: Clinical relevance, mechanisms, and laboratory approaches

Popis výsledku anglicky

Cardiac troponins are indispensable biomarkers for the diagnosis of acute myocardial infarction, but false-positive elevations that contradict the clinical picture remain a significant challenge in laboratory medicine. Analytical interferences may arise from macrotroponins, heterophile or anti-troponin antibodies, and the limited cardiac specificity of high-sensitivity troponin T (hs-cTnT) in skeletal muscle disease. Recent studies show that hs-cTnT is elevated in up to two-thirds of patients with myopathies, while high-sensitivity troponin I (hs-cTnI) is largely unaffected, underscoring the diagnostic advantage of hs-cTnI in this setting. A pragmatic diagnostic approach should combine clinical plausibility with stepwise laboratory testing. First, preanalytical factors such as sample mislabeling, fibrin clots, or hemolysis must be excluded and the measurement repeated. If the results remain incongruent, an alternative assay - ideally hs-cTnI - should be performed. Further evaluation may include heterophile-blocking reagents, polyethylene glycol precipitation to screen for macro-analytes, and, where available, confirmatory techniques such as gel filtration chromatography or immunoglobulin depletion (protein A/G). Although these strategies can help identify assay interference, there is no universally accepted gold standard. Awareness of false-positive elevations, careful interpretation of discordant troponin results, and effective collaboration between laboratories and clinicians are essential to prevent misdiagnosis and unnecessary interventions. Clear documentation of confirmed interferences further ensures safe patient management and provides guidance on which assays are reliable for future tests.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30100 - Basic medicine

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Physiological Research

ISSN

0862-8408

e-ISSN

1802-9973

Svazek periodika

74

Číslo periodika v rámci svazku

5

Stát vydavatele periodika

CZ - Česká republika

Počet stran výsledku

5

Strana od-do

885-889

Kód UT WoS článku

001631813000016

EID výsledku v databázi Scopus

2-s2.0-105020866848