New version of troponin test can detect heart attack within one hour

Mar 8 2018

When Marc Hammer went to the emergency room feeling fatigued and dizzy, he had no idea his life was actually at risk. "I'm an avid cyclist and walk five to 15 miles a day," said Hammer, "so you can imagine my shock when I found out I was facing a heart issue. It came out of the blue."

Doctors performed several tests to determine what was happening with Hammer's heart. "We wanted to rule out blockages in his coronary arteries," said Lori Daniels, MD, cardiologist at UC San Diego Health. "The blood tests came back normal, but it was determined that Marc needed a pacemaker to regulate his heart beat."

The pacemaker improved his symptoms briefly, but new symptoms appeared. "A few days after the procedure, I started to feel pressure in my chest and shortness of breath," said Hammer. "I was back in the hospital with questions."

When Hammer returned, his cardiologists decided to use a new version of the troponin test, which measures levels of troponin T in the blood, a protein released when heart muscle is damaged, such as during a heart attack. The more damage, the greater the amount of troponin T.

A simple blood draw and analysis revealed Hammer's troponin T levels were high. Normal levels range from less than 6 to 22 for men; Hammer's were up to 41. The results led to an angiogram, which found Hammer had a problem with his main coronary artery. "His heart was compressing his coronary artery and he was having a heart attack," said Daniels. "The new troponin test truly helped us put all the pieces of the puzzle together."

The fifth generation test was approved in the United States in 2017, and UC San Diego Health is the first hospital in California to use it. The new version is much more sensitive and can detect a heart attack within one hour versus three to six hours for previous generations. "It saved my life," said Hammer.

"Critical diagnoses rely on the biomarker troponin, and over the past 15 years, improvements in the sensitivity of the test have increased our ability to detect heart issues faster," said Robert Fitzgerald, PhD, clinical chemist at UC San Diego School of Medicine. "This next generation of test also has sex specific cutoffs, which is very important because females have a lower baseline."

During the two months of using the new troponin test, UC San Diego Health cardiologists also ran the previous version on patients for side-by-side comparisons.

"We saw a good number of cases where the results of the previous version showed normal results but the fifth generation showed abnormal results with some kind of cardiac issue going on," said Daniels. "This new test allows us to make decisions faster, administer immediate treatment when every minute counts, and also discharge patients earlier if their levels are normal."

The troponin test is primarily used in emergency departments and outpatient cardiology clinics.

"With sensitive tests like the fifth generation of troponin, we can identify new disease states and why heart cells are dying," said Fitzgerald. "Armed with this information, we could develop new life-saving therapies for the future."

One month after his diagnosis, Hammer is still recovering, slowly getting his energy back and adjusting to necessary medications.

"Everything is looking up," said Hammer. "I definitely don't take life for granted anymore."