Non-coronarogenic causes of elevated cardiac troponins in clinical practice (literature review)

Cardiac troponins (cTn) are the most sensitive and specific biomarkers of myocardial lesions; new highly sensitive methods allow the detection of even minor damage to the myocardium. However, elevated troponin levels indicate damage to the heart, but do not help to identify the cause and mechanism of damage. Therefore, increased cTn is typical of many heart disorders and does not necessarily indicate acute myocardial infarction. In routine clinical practice, the interpretation of positive troponins can be challenging. We cover the main non-coronarogenic causes of increased cardiac troponin levels.In the first part of this review, we discuss the mechanisms and diagnostic value of cardiac troponins after exercise, inflammatory and toxic myocardial lesions (endocarditis, myocarditis, and sepsis), and renal failure.In the second part of this review, we describe the mechanisms underlying the increase of troponin levels and their diagnostic value in pulmonary embolism, dissecting aortic aneurysms, neurogenic disorders (such as stroke and subarachnoid hemorrhages), treatment with cardiotoxic drugs (chemotherapy). Particular attention is paid to false positive results of troponin tests.