Elevated cardiac troponin in clinical scenarios beyond obstructive coronary artery disease

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.