What Is the Role of Serial High-Sensitivity Troponin Measurements in Chronic Heart Failure?

[摘要] In the past decade, there has been a veritable explosion of studies examining cardiac biomarkers in heart failure (HF).2 Among the many reasons for this fact is that measurements of such biomarkers as natriuretic peptides (the current gold standard biomarker for HF diagnosis, prognosis, and management decision-making) are easy and safe to obtain, and they can potentially reveal important information about the patient at the biological level. Another class of cardiac biomarkers, the cardiac troponins, also provides important information about the prognosis of patients with HF. Studies have shown that cardiac troponins are typically measurable and sometimes frankly increased in HF patients, with values being closely linked with the severity of illness. Patients with more severe HF usually show higher cardiac troponin concentrations, intriguingly often independently of a diagnosis of coronary artery disease. Interestingly, cardiac troponins have been shown to be independently prognostic in both acute HF (1) and chronic HF (2), even after adjusting for natriuretic peptide concentrations.With a new generation of high-sensitivity cardiac troponin assays now or soon to be available, it is possible to detect minute amounts of circulating cardiac troponins with high precision. A substantial percentage of the patients with HF have measurable cardiac troponin values in high-sensitivity assays, often above the 99th percentile for a normal healthy population. For example, in a prior study, Latini and colleagues used a high-sensitivity cardiac troponin T (hs-cTnT) assay to measure cTnT among patients in the Valsartan Heart Failure Trial (Val-HeFT) (3) and reported the biomarker to be measurable in 92% of the study participants and—importantly for prognosis—before and after an adjustment for natriuretic peptides. This finding is of importance for both monitoring and managing HF, because high-sensitivity cardiac troponin measurements could theoretically be leveraged for monitoring chronic HF stability. If therapies specifically tailored for ameliorating the …

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