Abstract
The use of cardiac troponins, and particularly with the advent of new high-sensitivity troponins, has come without adequate discussion of the proper interpretation, limitation of values, and their best use in heart failure (HF) patients. The objective of this chapter is to provide a balanced assessment of how cardiac troponins are advocated for clinical use in HF patients and areas where there are gaps in knowledge that are important for clinicians to appreciate.
Although biomarkers such as troponin add to the magnitude of risk prediction, it is unclear how often their use leads to changes in treatment. The use of serial troponin testing over time would be helpful. To do this, it is necessary to take into account assay characteristics and the analytical and biological variability in addition to the ability to define normal values and effectively monitor therapy. These factors are often overlooked leading to conclusions that may not be clinically or analytically sound. An understanding of the value and limitations of troponin use is important to all clinicians who manage HF patients. If used optimally, troponin values will likely be helpful in defining when and how to effectively intervene clinically.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Newby LK, Jesse RL, Babb JD, Christenson RH, DeFer TM, ACCF, et al. Expert consensus document on the practical clinical considerations in the interpretation of troponin elevations. J Am Coll Cardiol. 2012;2012(60):2419–55.
Gore MO, Seliger SL, deFilippi CR, Namabi V, Christenson RH, Hashim IA, et al. Age and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol. 2014;63:1441–8.
Miller WL, Hartman KA, Burritt MF, Grill DE, Rodeheffer RJ, Burnett Jr JC, Jaffe AS. Serial biomarker measurements in ambulatory patients with chronic heart failure – the importance of change over time. Circulation. 2007;116:249–57.
Apple FS, Collinson PO, IFCC task force on clinical applications of cardiac biomarkers. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem. 2012;58:54–61.
Collinson PO, Heung YM, Gaze D, Boa F, Senior F, Christenson R, Apple FS. Influence of population selection on the 99th percentile reference value of cardiac troponin assays. Clin Chem. 2012;58:219–25.
McKie PM, Heublein DM, Scott CG, Gantzer ML, Mehta RA, Rodeheffer RJ, Redfield MM, Burnett JC, Jaffe AS. Defining high-sensitivity cardiac troponin concentrations in the community. Clin Chem. 2013;59:1099–107.
Sandoval Y, Apple FS. The global need to define normality: the 99th percentile value of cardiac troponin. Clin Chem. 2014;60:455–62.
Hickman PE, Lindahl B, Potter JM, Venge P, Koerbin G, Eggers KM. Is it time to do away with the 99th percentile for cardiac troponin in the diagnosis of acute coronary syndrome and the assessment of cardiac risk? Clin Chem. 2014;60:734–6.
deLemos JA, Drazner MH, Omland T, Ayers CR, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304:2503–12.
deFillippi CR, deLemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL. Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010;304:2494–502.
Vasile VC, Saenger AK, Kroning JM, Jaffe AS. Biological and analytical variability of a novel high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:1086–90.
Bais R. The effect of sample hemolysis on cardiac troponin I and T assays. Clin Chem. 2010;56:1357–9.
Apple FS, Parvin CA, Buechler KF, Christenson RH, Wu AHB, Jaffe AS. Validation of the 99th percentile cutoff independent of assay imprecision (CV) for cardiac troponin monitoring for ruling out myocardial infarction. Clin Chem. 2005;51:2198–200.
Panteghini M, Pagani F, Yeo KT, Apple FS, Christenson RH, Dati F, et al. Evaluation of the imprecision at low-range concentrations of the assays for cardiac troponin determination. Clin Chem. 2004;50:327–32.
Kociol RD, Pang PS, Gheorghiade M, Fonarow GC, O’Connor CM, Felker GM. Troponin elevation in heart failure. J Am Coll Cardiol. 2010;56:1071–8.
Januzzi Jr JL, 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;33:2265–71.
Latini R, Masson S, Anand IS, Missov E, Carlson M, Vago T, for the Val-HeFT Investigators, et al. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation. 2007;116:1242–9.
Peacock WF, DeMarco T, Fonarow GC, Diercks D, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358:2117–26.
Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation. 2001;103:369–74.
Perna ER, Macin SM, Canella JPC, Alvargenga PM, Rios NG, Pantich R, et al. Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with decompensated heart failure. Int J Cardiol. 2005;99:253–61.
Miller WL, Hartman KA, Burritt MF, Grill DE, Jaffe AS. Profiles of serial changes in cardiac troponin T concentrations and outcomes in ambulatory patients with chronic heart failure. J Am Coll Cardiol-Heart Fail. 2009;54(18):1715–21.
Ishii J, Cui K, Kitagawa F, et al. Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure. Clin Chem. 2003;49:2020–6.
Maron BA, Leopold JA. Aldosterone receptor antagonists. Effective but often forgotten. Circulation. 2010;121:934–9.
Miller WL, Hartman KA, Grill DE, Struck J, Bergmann A, Jaffe AS. Serial measurements of mid-region-pro-ANP and C-terminal-pro-vasopressin (copeptin) in relation to B-type natriuretic peptide and troponin T in ambulatory chronic heart failure patients – incremental prognostic value. Heart (BHJ). 2012;98:389–94.
Miller WL, Hartman KA, Grill DE, Burnett JC, Jaffe AS. Only large reductions in natriuretic peptide concentrations (BNP and NT-proBNP) are associated with improved outcomes in ambulatory patients with chronic heart failure. Clin Chem. 2009;55(1):78–84.
Forfia PR, Watkins SP, Rame E, Stewart KJ, Shapiro EP. Relationship between B-type natriuretic peptides and pulmonary capillary wedge pressure in the intensive care unit. J Am Coll Cardiol. 2005;45:1667–71.
Cioffi G, Tarantini L, Stefenelli C, Azzetti G, Marco R, Carlucci S, Furlanello F. Changes in plasma N-terminal proBNP levels and ventricular filling pressures during intensive unloading therapy in elderly with decompensated congestive heart failure and preserved left ventricular systolic function. J Card Fail. 2006;12:608–15.
Latini R, Masson S, Wong M, Barlera S, Carretta E, et al. Incremental prognostic value of changes in B-type natriuretic peptide in heart failure. Am J Med. 2006;119:70e23–30.
Anand IS, Fisher LD, Chiang Y-T, Latini R, Masson S, Maggioni AP, Glazer RD, Tognoni G, Cohn JN. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation. 2003;107:1278–83.
Neeland IJ, Dranzer MH, Berry JD, Ayers CR, de Filippi C, Seliger SL, Nambi V, McGuire DK, Omland T, de Lemos JA. Biomarkers of chronic cardiac injury and hemodynamic stress identify a malignant phenotype of left ventricular hypertrophy in the general population. J Am Coll Cardiol. 2013;61:187–95.
Li X, Qi Y, Li Y, Zhang S, Guo S, Chu S, Gao P, Zhu D, Wu Z, Lu L, Shen W, Jai N, Niu W. Impact of mineralocorticoid receptor antagonists on changes in cardiac structure and function of left ventricular dysfunction. Circ Heart Fail. 2013;6:156–65.
Weir RAP, Miller AM, Murphy GEJ, et al. Serum soluble ST2: a potential novel mediator in left ventricular and infarct remodeling after acute myocardial infarction. J Am Coll Cardiol. 2010;55:243–50.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Miller, W.L. (2016). Use of Cardiac Troponin in Patients with Heart Failure. In: Maisel, A., Jaffe, A. (eds) Cardiac Biomarkers. Springer, Cham. https://doi.org/10.1007/978-3-319-42982-3_7
Download citation
DOI: https://doi.org/10.1007/978-3-319-42982-3_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-42980-9
Online ISBN: 978-3-319-42982-3
eBook Packages: MedicineMedicine (R0)