Clinical Information

Troponin T is a myofibrillar protein found in striated musculature. There are 2 types of myofilament, a thick filament containing myosin and a thin filament consisting of 3 different proteins: actin, tropomyosin, and troponin. Troponin is itself a complex of 3 protein subunits: troponin T, troponin I, and troponin C. Troponin T binds the troponin complex to tropomyosin. Troponin I inhibits actomyosin ATPase in relation to the calcium concentration. Troponin C, with its 4 binding sites for calcium, mediates calcium dependency.

In the cytosol, troponin T is found in both free and protein-bound forms. The unbound (free) pool of troponin T is the source of the troponin T released in the early stages of myocardial damage. Bound troponin T is released from the structural elements at a later stage, corresponding with the degradation of myofibrils that occurs in irreversible myocardial damage. The most common cause of cardiac injury is myocardial ischemia, ie, acute myocardial infarction. Troponin T becomes elevated 2 to 4 hours after the onset of myocardial necrosis, and can remain elevated for up to 14 days.

Elevations in troponin T are also seen in patients with unstable angina. The finding of unstable angina and an elevated troponin T are known to have adverse short- and long-term prognoses, as well as a unique beneficial response to an invasive interventional strategy and treatment with the newer antiplatelet agents and low-molecular-weight heparin.