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      Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease

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          In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.

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          Most cited references 44

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          Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature.

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                Author and article information

                Med Sci Monit
                Med. Sci. Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                22 September 2019
                : 25
                : 7115-7125
                [1 ]Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, U.S.A.
                [2 ]Scientific Clinical Institutes Maugeri, Cardiac Rehabilitation Lumezzane Institute, Brescia, Italy
                [3 ]Center for Heart and Vessel Preclinical Studies, Department of Internal Medicine, St. John Hospital and Medical Center, Wayne State University, Detroit, MI, U.S.A.
                [4 ]Division of Human Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
                [5 ]General Medical Education, Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, U.S.A.
                [6 ]Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
                [7 ]Department of Medicine, Ascension St. John Hospital and Wayne State University School of Medicine, Detroit, MI, U.S.A.
                Author notes
                Corresponding Author: Tiziano Scarabelli, e-mail: tscarabelli@

                Study Design


                Data Collection


                Statistical Analysis


                Data Interpretation


                Manuscript Preparation


                Literature Search


                Funds Collection


                Michael Sternberg, Evasio Pasini and Carol Chen-Scarabelli equally contributed to this work


                Giuseppe Faggian, Tiziano Scarabelli and Louis Saravolatz equally contributed as senior authors of the manuscript

                © Med Sci Monit, 2019

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

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