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, namely actin, tropomyosin, and troponin. Troponin is itself a complex of 3 protein subunits, which are termed 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 has 4 binding sites for calcium and mediates calcium dependency

Troponin T is found in free cytosol and structurally bound protein. The unbound pool of troponin T is the source of early protein release in myocardial damage. Troponin T is released from the structural elements at a later stage, corresponding to the degradation of myofibrils that occurs in irreversible myocardial damage. Troponin T becomes elevated 2 to 4 hours after the onset of myocardial necrosis and can remain elevated for up to 14 days, or even longer on occasion.

The most common cause of cardiac injury is myocardial ischemia (ie, acute myocardial infarction). These patients are known to have an adverse short- and long-term prognosis compared to patients with unstable angina and no elevation of troponin T. Many of these patients, especially those with troponin T elevations above 30 ng/L, benefit from an aggressive strategy with anticoagulation and an invasive interventional strategy.