Troponins in heart failure
T Omland1, H Røsjø1, E Giannitsis2
1Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway.
Insights
Cardiac troponins (cardiac troponin I and T) show promise as biomarkers for heart failure diagnosis and prognosis. High-sensitivity assays reveal their presence in various conditions, aiding risk assessment.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Heart failure signs and symptoms are often nonspecific and correlate poorly with objective cardiac function assessments.
- Existing diagnostic tools like echocardiography have limitations in reflecting symptomatic status and functional capacity.
- There is a critical need for reliable circulating biomarkers to enhance heart failure diagnosis and prognosis.
Purpose of the Study:
- To review the clinical performance and utility of cardiac troponin measurements in heart failure.
- To evaluate cardiac troponins as diagnostic and prognostic tools in symptomatic and asymptomatic left ventricular dysfunction.
- To assess the role of cardiac troponins in high-risk phenotypes for developing heart failure.
Main Methods:
- Review of current literature on cardiac troponin I and T assays.
- Analysis of high-sensitivity assays for detecting low circulating concentrations of cardiac troponins.
- Evaluation of diagnostic and prognostic information provided by troponin measurements in various cardiac conditions.
Main Results:
- High-sensitivity cardiac troponin assays improve diagnostic accuracy in acute coronary syndromes.
- Cardiac troponins are frequently detected in chronic circulation across diverse cardiac and non-cardiac diseases, including heart failure.
- Cardiac troponin I and T provide valuable prognostic information for future heart failure development and adverse events in established heart failure.
Conclusions:
- Cardiac troponins are emerging as crucial biomarkers in heart failure management.
- Troponin measurements offer incremental diagnostic and prognostic value beyond traditional assessments.
- These biomarkers are useful in asymptomatic individuals with left ventricular dysfunction and those at high risk for heart failure.
Abstract:
The signs and symptoms of heart failure are frequently unspecific and correlate poorly with objective indices of cardiac function. Objective assessment of cardiac function by echocardiography or other imaging modalities also correlate poorly with symptomatic status and functional capacity. Accordingly, there is a need for circulating biomarkers that can provide incremental diagnostic and prognostic information to the existing armamentarium of tests. The introduction of more sensitive assays that allow determination of very low circulating concentrations of the myofibrillar proteins cardiac troponin I and T has not only resulted in improved diagnostic accuracy in the setting of acute coronary syndromes. The high sensitivity assays have also shown that cardiac troponins are frequently found chronically circulating in a variety of acute and chronic, cardiac and non-cardiac disease conditions, including acute heart failure and chronic symptomatic and asymptomatic left ventricular dysfunction. Cardiac troponin I and T provide may provide clinically useful prognostic information both concerning the future risk of developing heart failure in asymptomatic subjects and the risk of fatal events and hospital admissions in those with already established heart failure This review summarizes current literature on the clinical performance and utility of cardiac troponin measurements as diagnostic and prognostic tools in patients with symptomatic heart failure, as well as in those with asymptomatic left ventricular dysfunction, and clinical phenotypes at high risk for developing heart failure, including stable coronary artery disease, left ventricular hypertrophy, and aortic stenosis.
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