Raised cardiac troponins: Troponins seem to be sensitive but not specific

doi:10.1136/bmj.329.7457.111

BMJ 2004;329:111 (10 July), doi:10.1136/bmj.329.7457.111

Letter

Raised cardiac troponins

Troponins seem to be sensitive but not specific

The first 150 words of the full text of this article appear below.

EDITOR—The initial statement in Ammann et al's editorialon raised cardiac troponins, "Troponin T and troponin I arehighly sensitive and specific markers of myocardial injury,"is contradicted by a later statement: "In sepsis, for example,cardiac troponins are raised in up to 85% of patients in theabsence of any acute coronary syndromes."¹

Although troponins are clearly highly sensitive for acute coronarysyndromes, and therefore valuable for risk stratification inpatients presenting with classic cardiac chest pain, the realissue is the specificity of troponin assays when randomly appliedin general medical admissions units to patients presenting asunwell (and not necessarily with cardiac syndromes). Given ahigh false positive rate in non-cardiac conditions—sepsissyndromes, eclampsia, and others—their specificity mustbe suspect.

Not unusually, an admitting junior doctor merrily "ticks allthe boxes" on the clinical chemistry form and the patient (whoclearly has pneumonia, without cardiac . . . [Full text of this article]

Matthew L Grove, consultant rheumatologist

Tyneside General Hospital, North Shields NE29 8NH Matthew.Grove@northumbria-healthcare.nhs.uk