Quarterly Focus Issue: Prevention/Outcome
State-of-the-Art Paper
Troponin Elevation in Heart Failure: Prevalence, Mechanisms, and Clinical Implications

https://doi.org/10.1016/j.jacc.2010.06.016Get rights and content
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Circulating biomarkers have become increasingly important in diagnosing and risk stratifying patients with heart failure (HF). While the natriuretic peptides have received much focus, there is increasing interest in the role of circulating cardiac troponin (cTn) in detecting myocardial injury (often subclinical) in those with HF. Accumulating evidence suggests that patients with chronic and acute HF may have measurable levels of circulating cTn, whose detection and magnitude may have prognostic implications. Furthermore, as new, more sensitive cTn assays are being developed, larger numbers of HF patients are found to have detectable cTn with a persistent relationship between magnitude and outcome. This knowledge improves our ability to understand the mechanism of worsening HF, improve risk stratification, and detect potential injury related to new therapeutics in HF. As investigators begin to understand the relationship of detectable cTn to HF outcomes, as well as temporal changes in its magnitude, and its relationship to other circulating biomarkers, more insight may be gained into the progressive nature of cardiac dysfunction and the transition from chronic compensated to acute decompensated HF. Ultimately, this information might allow physicians to guide therapy, choose appropriate therapeutics, and improve HF outcomes.

Key Words

biomarkers
heart failure
outcomes

Abbreviations and Acronyms

ACS
acute coronary syndrome
BNP
B-type natriuretic peptide
CHF
chronic heart failure
cTn
cardiac troponin
HF
heart failure
H-FABP
heart-type fatty acid binding protein
HR
heart rate
hsTnT
high-sensitivity troponin T
MI
myocardial infarction
NT-proBNP
N-terminal pro–B-type natriuretic peptide

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Dr. Kociol has received funding from an American Heart Association Pharmaceutical Roundtable outcomes traininggrant (0875142N). Dr. Pang has served as a consultant for Astellas, Bayer, EKR Therapeutics, Johnson & Johnson, The Medicines Company, Otsuka, Palatin Technologies, PDL BioPharma, Pericor Therapeutics, and Solvay Pharmaceuticals; has received honoraria from BiogenIdec, Corthera, Ikaria, and Nile Therapeutics; and has received research support from Merckand PDL BioPharma. Dr. Gheorghiade has served as a consultant for Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma AG, CorThera, Cytokinetics, DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay Pharmaceuticals, and Trevena Therapeutics; and has received significant (>$10,000) support from Bayer Schering Pharma AG, DebioPharm S.A., Medtronic, Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau, Solvay Pharmaceuticals, and Pericor Therapeutics. Dr. Fonarow has received research support from the National Heart, Lung, and Blood Institute; consulting fees from GlaxoSmithKline, Medtronic, Novartis, and Scios; and honoraria from GlaxoSmithKline and Medtronic. Dr. O'Connor has received research support from the National Institutes of Healthand Roche Diagnostics; and has served as a consultant for Merck, Medtronic, Forest, GE Healthcare, Amgen, Medpace, Actelion, Johnson & Johnson, Novella, Roche Diagnostics, and Trevena. Dr. Felker has received research support from Roche Diagnostics, BG Medicine, Otsuka, and Cytokinetics; and consulting fees from Corthera, Amgen, Cytokinetics, and XDX.