Cardiac troponins frequently provide evidence of ongoing myocyte damage in patients with suspected myocarditis when CK-MB levels are within the normal range but remain limited as a diagnostic test by poor sensitivity. Nevertheless, owing to the similarly modest sensitivity of endomyocardial biopsy (the "gold standard" for diagnosis), some experts have recommended measurement of cardiac troponin and correlation with the results of histological assessment in all patients with suspected myocarditis (42). When elevated levels of troponin are detected in the absence of histological and/or immunohistological evidence of myocarditis, sampling error of the biopsy is a strong possibility; however, other nonischemic and ischemic causes of myocyte necrosis should be considered. Conversely, myocarditis should be among the diagnostic possibilities for patients presenting with chest symptoms and elevated troponins who subsequently are shown to be free of significant epicardial coronary disease.
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