The specificity of biochemical markers of cardiac damage: a problem solved

This paper reviews the tissue specificity of cardiac troponin I (cTnI), cardiac troponin T (cTnT) and creatine kinase (CK) MB in human and animal heart and skeletal muscles. Studies reveal that Oh-MB can be expressed up to 20% of total CK activity in human skeletal muscle; and therefore is not 100% specific for the heart. One cTnI isoform has been described and shown to be 100% specific for the heart. While one to four cTnT isoforms are expressed in diseased and regenerating human skeletal muscle, these isoforms are not the same as the cTnT isoforms expressed in the human heart and are not detected by the cTnT diagnostic assays used in clinical practice. Representative cases are described demonstrating the role of monitoring cardiac troponins in blood for differentiating false positive CKMB increases due to skeletal muscle injury. Further, sufficient reactivity and tissue specificity of cTnI and cTnT assays are demonstrated for use as markers of myocardial injury in laboratory animals. Monitoring cTnI and cTnT concentrations in the circulation appears poised as the new standards for detection of myocardial injury.