Cardiac Troponin: Fragments of the Future?

Cardiac troponin is the gold standard biomarker for the diagnosis of acute myocardial infarction (AMI). Development of high-sensitivity troponin platforms has revolutionized triage of chest pain patients, but specificity for type 1 AMI remains a clinical limitation. Consequently, differentiating type 1 AMI from other forms of myocardial injury is a common conundrum, heightened by the risks associated invasive coronary angiography. The troponin complex is a dynamic structure comprising of 3 subunits which variably fragment prior to measurement in the blood. Documenting the fragmentation patterns of cardiac troponin may help identify the cause of myocardial injury. This review explores the biology underlying troponin fragmentation and summarizes multiple lines of evidence that it can improve the specificity for diagnosis of type 1 AMI.