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An Update on Cardiac Troponins as Circulating Biomarkers in Heart Failure

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Abstract

Circulating troponins and natriuretic peptides are the only biomarkers specifically released from cardiac myocytes that can be determined with robust and sensitive analytical methods, even in healthy subjects. These intracellular proteins are released from reversibly or irreversibly damaged cardiac myocytes into the bloodstream by mechanisms that are not entirely clear. The recent introduction of a new generation of highly sensitive assays of cardiac troponin I or T has not only improved the early diagnosis of acute myocardial infarction but also suggested that there are several causes for troponin release other than acute coronary syndromes. Circulating troponins are elevated in patients with acute or chronic heart failure and are strongly associated with outcome, independently of natriuretic peptides, the benchmark biomarkers in heart failure. In the absence of further experimental evidences, the pathophysiologic basis for the elevation of circulating cardiac troponins in patients with stable chronic heart failure remains speculative.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction: Universal definition of myocardial infarction. Circulation 2007, 116:2634–2653.

    Article  PubMed  Google Scholar 

  2. Saenger AK, Jaffe AS: Requiem for a heavyweight: the demise of creatine kinase-MB: Circulation 2008, 118:2200–2206.

    PubMed  Google Scholar 

  3. • Keller T, Zeller T, Peetz D, et al.: Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009, 361:868–877. This clinical study shows that an hsTnI assay improves early diagnosis of acute MI compared with the traditional troponin assay, regardless of the time of chest pain onset.

  4. • Reichlin T, Hochholzer W, Bassetti S, et al.: Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009, 361:858–867. The diagnostic accuracy of four sensitive cardiac troponin assays is superior to a traditional assay in 718 consecutive patients who presented symptoms suggestive of acute MI in the emergency department.

  5. Katus HA, Giannitsis E, Jaffe AS, Thygesen K: Higher sensitivity troponin assays: quo vadis? Eur Heart J 2009, 30:127–128.

    Article  CAS  PubMed  Google Scholar 

  6. Omland T, de Lemos JA, Sabatine MS, et al.: A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 2009, 361:2538–2547.

    Article  CAS  PubMed  Google Scholar 

  7. • Kelley WE, Januzzi JL, Christenson RH: Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure. Clin Chem 2009, 55:2098–2112. This article provides a well-documented and comprehensive review on alternative causes of elevated cardiac troponins when acute coronary syndromes and heart failure are excluded.

  8. La Vecchia L, Mezzena G, Ometto R, et al.: Detectable serum troponin I in patients with heart failure of nonmyocardial ischemic origin. Am J Cardiol 1997, 80:88–90.

    Article  PubMed  Google Scholar 

  9. Missov E, Calzolari C, Pau B: Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997, 96:2953–2958.

    CAS  PubMed  Google Scholar 

  10. Sato Y, Yamada T, Taniguchi R, et al.: Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001, 103:369–374.

    CAS  PubMed  Google Scholar 

  11. Setsuta K, Seino Y, Ogawa T, et al.: Use of cytosolic and myofibril markers in the detection of ongoing myocardial damage in patients with chronic heart failure. Am J Med 2002, 113:717–722.

    Article  CAS  PubMed  Google Scholar 

  12. Ishii J, Nomura M, Nakamura Y, et al.: Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure. Am J Cardiol 2002, 89:691–695.

    Article  CAS  PubMed  Google Scholar 

  13. Healey JS, Davies RF, Smith SJ, et al.: Prognostic use of cardiac troponin T and troponin I in patients with heart failure. Can J Cardiol 2003, 19:383–386.

    CAS  PubMed  Google Scholar 

  14. Perna ER, Macin SM, Canella JP, et al.: Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation 2004, 110:2376–2382.

    Article  PubMed  Google Scholar 

  15. Ishii J, Cui W, 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, 49:2020–2026.

    Article  CAS  PubMed  Google Scholar 

  16. Bertinchant JP, Combes N, Polge A, et al.: Prognostic value of cardiac troponin T in patients with both acute and chronic stable congestive heart failure: comparison with atrial natriuretic peptide, brain natriuretic peptide and plasma norepinephrine. Clin Chim Acta 2005, 352:143–153.

    Article  CAS  PubMed  Google Scholar 

  17. Peacock WF 4th, De Marco T, Fonarow GC, et al.: Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008, 358:2117–2126.

    Article  CAS  PubMed  Google Scholar 

  18. Hudson MP, O’Connor CM, Gattis WA, et al.: Implications of elevated cardiac troponin T in ambulatory patients with heart failure: a prospective analysis. Am Heart J 2004, 147:546–552.

    Article  CAS  PubMed  Google Scholar 

  19. Dunlay SM, Gerber Y, Weston SA, et al.: Prognostic value of biomarkers in heart failure: application of novel methods in the community. Circ Heart Fail 2009, 2:393–400.

    Article  CAS  PubMed  Google Scholar 

  20. Sundström J, Ingelsson E, Berglund L, et al.: Cardiac troponin-I and risk of heart failure: a community-based cohort study. Eur Heart J 2009, 30:773–781.

    Article  PubMed  Google Scholar 

  21. Del Carlo CH, Pereira-Barretto AC, Cassaro-Strunz C, et al.: Serial measure of cardiac troponin T levels for prediction of clinical events in decompensated heart failure. J Card Fail 2004, 10:43–48.

    Article  PubMed  Google Scholar 

  22. Miller WL, Hartman KA, Burritt MF, et al.: Profiles of serial changes in cardiac troponin T concentrations and outcome in ambulatory patients with chronic heart failure. J Am Coll Cardiol 2009, 54:1715–1721.

    Article  CAS  PubMed  Google Scholar 

  23. Apple FS, Smith SW, Pearce LA, et al.: Use of the Centaur TnI-Ultra assay for detection of myocardial infarction and adverse events in patients presenting with symptoms suggestive of acute coronary syndrome. Clin Chem 2008, 54:723–728.

    Article  CAS  PubMed  Google Scholar 

  24. Giannitsis E, Kurz K, Hallermayer K, et al.: Analytical validation of high-sensitivity cardiac troponin T assay. Clin Chem 2009 Dec 3 (Epub ahead of print).

  25. Clerico A, Fortunato A, Ripoli A, et al.: Distribution of plasma cardiac troponin I values in healthy subjects: pathophysiological considerations. Clin Chem Lab Med 2008, 46:804–808.

    Article  CAS  PubMed  Google Scholar 

  26. Venge P, Johnston N, Lindahl B, James S: Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I access prototype assay and the impact on the diagnosis of myocardial ischemia. J Am Coll Cardiol 2009, 54:1165–1172.

    Article  CAS  PubMed  Google Scholar 

  27. •• Latini R, Masson S, Anand IS, et al.: Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 2007, 116:1242–1249. This article offered the first evidence obtained in a large international clinical trial that hsTnT is an independent and robust prognostic marker in more than 4000 patients with chronic and symptomatic HF.

  28. Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators: A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001, 345:1667–1675.

    Article  CAS  PubMed  Google Scholar 

  29. Logeart D, Beyne P, Cusson C, et al.: Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am Heart J 2001, 141:247–253.

    Article  CAS  PubMed  Google Scholar 

  30. Sato Y, Nishi K, Taniguchi R, et al.: In patients with heart failure and non-ischemic heart disease, cardiac troponin T is a reliable predictor of long-term echocardiographic changes and adverse cardiac events. J Cardiol 2009, 54:221–230.

    Article  PubMed  Google Scholar 

  31. •• Braunwald E. Biomarkers in heart failure. N Engl J Med 2008, 358:2148–2159. This article provides an outstanding state-of-the-art review on biomarkers in HF.

  32. Olivetti G, Giordano G, Corradi D, et al.: Gender differences and aging: effects on the human heart. J Am Coll Cardiol 1995, 26:1068–1079.

    Article  CAS  PubMed  Google Scholar 

  33. Capasso JM, Malhotra A, Li P, et al.: Chronic nonocclusive coronary artery constriction impairs ventricular function, myocardial structure, and cardiac contractile protein enzyme activity in rats. Circ Res 1992, 70:148–162.

    CAS  PubMed  Google Scholar 

  34. Olivetti G, Abbi R, Quaini F, et al.: Apoptosis in the failing human heart. N Engl J Med 1997, 336:1131–1141.

    Article  CAS  PubMed  Google Scholar 

  35. Narula J, Pandey P, Arbustini E, et al.: Apoptosis in heart failure: release of cytochrome c from mitochondria and activation of caspase-3 in human cardiomyopathy. Proc Natl Acad Sci USA 1999, 96:8144–8149.

    Article  CAS  PubMed  Google Scholar 

  36. Sobel BE, LeWinter MM: Ingenuous interpretation of elevated blood levels of macromolecular markers of myocardial injury: a recipe for confusion. J Am Coll Cardiol 2000, 35:1355–1358.

    Article  CAS  PubMed  Google Scholar 

  37. Jeremias A, Gibson CM: Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med 2005, 142:786–791.

    PubMed  Google Scholar 

  38. Tsutamoto T, Kawahara C, Yamaji M, et al.: Relationship between renal function and serum cardiac troponin T in patients with chronic heart failure. Eur J Heart Fail 2009, 11:653–658.

    Article  CAS  PubMed  Google Scholar 

  39. Fishbein MC, Wang T, Matijasevic M, Hong L, Apple FS: Myocardial tissue troponins T and I. An immunohistochemical study in experimental models of myocardial ischemia. Cardiovasc Pathol 2003, 12:65–71.

    Article  CAS  PubMed  Google Scholar 

  40. Zhang J, Knapton A, Lipshultz SE, et al.: Isoproterenol-induced cardiotoxicity in sprague-dawley rats: correlation of reversible and irreversible myocardial injury with release of cardiac troponin T and roles of iNOS in myocardial injury. Toxicol Pathol 2008, 36:277–278.

    Article  PubMed  Google Scholar 

  41. Apple FS, Murakami MM, Ler R, et al.: Analytical characteristics of commercial cardiac troponin I and T immunoassays in serum from rats, dogs, and monkeys with induced acute myocardial injury. Clin Chem 2008, 54:1982–1989.

    Article  CAS  PubMed  Google Scholar 

  42. • O’Brien PJ: Cardiac troponin is the most effective translational safety biomarker for myocardial injury in cardiotoxicity. Toxicology 2008, 245:206–218. This review discusses why cardiac troponins are the preferred translational and safety biomarker for myocardial injury and cardiotoxicity in animal models.

  43. Prontera C, Fortunato A, Storti S, et al.: Evaluation of analytical performance of the Siemens ADVIA TnIultra immunoassay. Clin Chem 2007, 53:1722–1723.

    Article  CAS  PubMed  Google Scholar 

  44. Kavsak PA, MacRae AR, Yerna MJ, Jaffe AS: Analytic and clinical utility of a next-generation, highly sensitive cardiac troponin I assay for early detection of myocardial injury. Clin Chem 2009, 55:573–577.

    Article  CAS  PubMed  Google Scholar 

  45. Hedberg P, Valkama J, Suvanto E, et al.: Evaluation of innotrac aio! Second-generation cardiac troponin I assay: the main characteristics for routine clinical use. J Autom Methods Manag Chem 2006, 2006:39325.

  46. Sabatine MS, Morrow DA, de Lemos JA, et al.: Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35. Eur Heart J 2009, 30:162–169.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156, Milan, Italy

    Serge Masson & Roberto Latini

  2. VA Medical Center and University of Minnesota Medical School, One Veterans Drive 111-C, Minneapolis, MN, 55417, USA

    Inder S. Anand

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  1. Serge Masson
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  2. Roberto Latini
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  3. Inder S. Anand
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Correspondence to Serge Masson.

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Masson, S., Latini, R. & Anand, I.S. An Update on Cardiac Troponins as Circulating Biomarkers in Heart Failure. Curr Heart Fail Rep 7, 15–21 (2010). https://doi.org/10.1007/s11897-010-0001-0

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