Abstract
Purpose of Review
To review the role of cardiac troponin (cTn) for prognosis in acute and chronic heart failure, and for predicting heart failure; and to explore the association between troponin and response to heart failure therapies, with an eye toward a possible role for troponin in a personalized approach to heart failure management, beyond prognosis.
Recent Findings
A number of therapies, including the neprilysin inhibitor sacubitril/valsartan and sodium-glucose cotransporter-2 inhibitors, have recently been shown to improve outcomes in heart failure patients. Most studies suggest that these agents improve outcomes regardless of baseline cTn concentration, but have greater absolute benefit among patients with highest cTn and baseline risk.
Summary
Troponin is prognostic across the heart failure spectrum, but whether it can significantly help with heart failure prevention and with tailoring and guiding heart failure treatments and interventions remains unknown.
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References
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Latini R, Masson S, Anand IS, Missov E, Carlson M, Vago T, et al. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation. 2007;116(11):1242–9.
Aimo A, Januzzi JL Jr, Vergaro G, Ripoli A, Latini R, Masson S, et al. Prognostic value of high-sensitivity troponin T in chronic heart failure: an individual patient data meta-analysis. Circulation. 2018;137(3):286–97.
Gravning J, Askevold ET, Nymo SH, Ueland T, Wikstrand J, McMurray JJ, et al. Prognostic effect of high-sensitive troponin T assessment in elderly patients with chronic heart failure: results from the CORONA trial. Circ Heart Fail. 2014;7(1):96–103.
Yousufuddin M, Abdalrhim AD, Wang Z, Murad MH. Cardiac troponin in patients hospitalized with acute decompensated heart failure: a systematic review and meta-analysis. J Hosp Med. 2016;11(6):446–54.
Yancy CW, Jessup M, Bozkurt B, Masoudi FA, Butler J, McBride PE et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013.
• Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895–e1032. These most recent US heart failure clinical practice guidelines provide updated recommendations regarding the use of troponin in heart failure.
Januzzi JL Jr, Filippatos G, Nieminen M, Gheorghiade M. Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section. Eur Heart J. 2012;33(18):2265–71.
Peacock WFT, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358(20):2117–26.
Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, et al. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med. 2009;361(26):2538–47.
Omland T, Pfeffer MA, Solomon SD, de Lemos JA, Rosjo H, Saltyte Benth J, et al. Prognostic value of cardiac troponin I measured with a highly sensitive assay in patients with stable coronary artery disease. J Am Coll Cardiol. 2013;61(12):1240–9.
Biener M, Giannitsis E, Kuhner M, Zelniker T, Mueller-Hennessen M, Vafaie M, et al. Prognostic value of high-sensitivity cardiac troponin T compared with risk scores in stable cardiovascular disease. Am J Med. 2017;130(5):572–82.
de Lemos JA, Drazner MH, Omland T, Ayers CR, Khera A, Rohatgi A, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304(22):2503–12.
deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, et al. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010;304(22):2494–502.
Seliger SL, Hong SN, Christenson RH, Kronmal R, Daniels LB, Lima JAC, et al. High-sensitive cardiac troponin T as an early biochemical signature for clinical and subclinical heart failure: MESA (Multi-Ethnic Study of Atherosclerosis). Circulation. 2017;135(16):1494–505.
Myhre PL, Claggett B, Ballantyne CM, Selvin E, Rosjo H, Omland T, et al. Association between circulating troponin concentrations, left ventricular systolic and diastolic functions, and incident heart failure in older adults. JAMA Cardiol. 2019;i4(10):997–1006.
Packer M, McMurray JJ, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation. 2015;131(1):54–61.
• Murphy SP, Prescott MF, Maisel AS, Butler J, Pina IL, Felker GM, et al. Association between angiotensin receptor-neprilysin inhibition, cardiovascular biomarkers, and cardiac remodeling in heart failure with reduced ejection fraction. Circ Heart Fail. 2021;14(6):e008410. Subanalysis showing the association and interaction between cardiac biomarkers and the effect of sacubitril/valsartan on outcomes in HFrEF patients.
Jhund PS, Claggett BL, Voors AA, Zile MR, Packer M, Pieske BM et al. Elevation in high-sensitivity troponin T in heart failure and preserved ejection fraction and influence of treatment with the angiotensin receptor neprilysin inhibitor LCZ696. Circ Heart Fail. 2014;7(6):953–9.
• Gori M, Senni M, Claggett B, Liu J, Maggioni AP, Zile M, et al. Integrating high-sensitivity troponin T and sacubitril/valsartan treatment in HFpEF: the PARAGON-HF trial. JACC Heart Fail. 2021;9(9):627–35. Subanalysis showing the association and interaction between cardiac troponin and the effect of sacubitril/valsartan on outcomes in HFpEF patients.
• Berg DD, Docherty KF, Sattar N, Jarolim P, Welsh P, Jhund PS et al. Serial assessment of high-sensitivity cardiac troponin and the effect of dapagliflozin in patients with heart failure with reduced ejection fraction: an analysis of the DAPA-HF trial. Circulation. 2022;145(3):158–69. Subanalysis showing the association and interaction between cardiac troponin and the effect of dapagliflozin on outcomes in HFrEF patients.
Zelniker TA, Morrow DA, Mosenzon O, Goodrich EL, Jarolim P, Murphy SA, et al. Relationship between baseline cardiac biomarkers and cardiovascular death or hospitalization for heart failure with and without sodium-glucose co-transporter 2 inhibitor therapy in DECLARE-TIMI 58. Eur J Heart Fail. 2021;23(6):1026–36.
• Packer M, Januzzi JL, Ferreira JP, Anker SD, Butler J, Filippatos G et al. Concentration-dependent clinical and prognostic importance of high-sensitivity cardiac troponin T in heart failure and a reduced ejection fraction and the influence of empagliflozin: the EMPEROR-Reduced trial. Eur J Heart Fail. 2021;23(9):1529–38. Subanalysis showing the association and interaction between cardiac troponin and the effect of empagliflozin on outcomes in HFrEF patients.
• Januzzi JL, Jr., Butler J, Zannad F, Filippatos G, Ferreira JP, Pocock SJ et al. Prognostic implications of N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T in EMPEROR-Preserved. JACC Heart Fail. 2022;10(7):512–24. Subanalysis showing the association and interaction between cardiac biomarkers and the effect of empagliflozin on outcomes in HFpEF patients.
Myhre PL, O’Meara E, Claggett BL, de Denus S, Jarolim P, Anand IS, et al. Cardiac troponin I and risk of cardiac events in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2018;11(11):e005312.
Myhre PL, Vaduganathan M, O’Meara E, Claggett BL, de Denus S, Jarolim P, et al. Mechanistic effects of spironolactone on cardiovascular and renal biomarkers in heart failure with preserved ejection fraction: a TOPCAT biorepository study. Circ Heart Fail. 2020;13(1):e006638.
Ledwidge M, Gallagher J, Conlon C, Tallon E, O’Connell E, Dawkins I, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013;310(1):66–74.
Daniels LB, Barrett-Connor E. Can natriuretic peptides help identify heart failure patients for whom statins are beneficial? J Am Coll Cardiol. 2009;54(20):1860–1.
Anand IS, Rector TS, Cleland JG, Kuskowski M, McKelvie RS, Persson H, et al. Prognostic value of baseline plasma amino-terminal pro-brain natriuretic peptide and its interactions with irbesartan treatment effects in patients with heart failure and preserved ejection fraction: findings from the I-PRESERVE trial. Circ Heart Fail. 2011;4(5):569–77.
Felker GM, Fiuzat M, Thompson V, Shaw LK, Neely ML, Adams KF, et al. Soluble ST2 in ambulatory patients with heart failure: association with functional capacity and long-term outcomes. Circ Heart Fail. 2013;6(6):1172–9.
Januzzi JL Jr, Canty JM, Das S, DeFilippi CR, Gintant GA, Gutstein DE, et al. Gaining efficiency in clinical trials with cardiac biomarkers: JACC review topic of the week. J Am Coll Cardiol. 2021;77(15):1922–33.
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LBD has received consulting fees from Quidel, Roche Diagnostics, and Siemens; and has served on Clinical Endpoints Adjudication Committees for Abbott and Applied Therapeutics. DA declares that he has no conflict of interest.
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Agdashian, D., Daniels, L.B. What Is the Clinical Utility of Cardiac Troponins in Heart Failure? Are They Modifiable Beyond Their Prognostic Value?. Curr Heart Fail Rep 20, 33–43 (2023). https://doi.org/10.1007/s11897-023-00588-z
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DOI: https://doi.org/10.1007/s11897-023-00588-z