Macrotroponin: A Case Series and Review of the Literature

Cardiac troponin is a cornerstone biomarker in assessing myocardial injury, yet its interpretation is nuanced by conditions such as macrotroponins—benign immunoglobulin-troponin complexes that may result in false increases. This article presents three cases of macrotroponin-associated troponin increase, each demonstrating the diagnostic challenges posed by persistent troponin increases without clinical evidence of myocardial injury. Diagnostic workups, including imaging and immunoglobulin depletion assays, confirmed macrotroponin presence in all cases. A comprehensive literature review highlights the prevalence, mechanisms, and clinical implications of macrotroponins, emphasising the need for careful interpretation of troponin levels in biochemical-clinical discordance. The findings underscore the importance of collaboration between clinicians and laboratories to mitigate unnecessary investigations and optimise patient care.