Cardiac troponin: tracking its journey in cells and patients

Current guidelines for diagnosing myocardial infarction after cardiac surgery contradict each other on the type of biomarker and on diagnostic criteria. Therefore this thesis investigated cardiac biomarker kinetics in bypass patients with an uncomplicated trajectory and proposed new diagnostic cut-off concentrations. Additionally, after introduction of the high-sensitivity cardiac troponin assays, cardiac troponin elevations are more also found in patients not diagnosed with a myocardial infarction, such as end-stage renal disease patients and even in seemingly healthy individuals such as athletes. This makes it often difficult for physicians to differentiate between MI patients who need immediate treatment versus patients with more chronic cTn elevations that can have their follow-up at a later time. This thesis performed an in-depth analysis of circulating cardiac troponin T subforms, in relation to possible (pre-)analytical interferences, compares cardiac troponin T forms in myocardial infarction versus end-stage renal disease and gives mechanistic insights in cardiac troponin release from cardiomyocytes models.