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The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers

  • Biomarkers of Heart Failure (W Tang and J Grodin, Section Editors)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves—without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used.

Recent Findings

High-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays. In the realm of the natriuretic peptides, studies demonstrated states of natriuretic peptide deficiency in obesity and in subjects of African-American race. Regardless, BNP and NT-proBNP both retained prognostic utilities across a variety of comorbid conditions. We are rapidly gaining clinical evidence with use of soluble ST2 and procalcitonin levels in management of cardiac disease states.

Summary

In order to get the most utility from their measurement, one must be aware of non-cardiac pathologies that may affect the levels of biomarkers as although many of these are actually true values, they may not represent the disease we are trying to delineate.

A few take-home points are as follows:

  1. 1.

    A biomarker value should never be used without clinical context

  2. 2.

    Serial sampling of biomarkers is often helpful

  3. 3.

    Panels of biomarkers may be valuable

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of California, San Diego, 9434 Medical Center Drive, La Jolla, CA, 92037, USA

    Marin Nishimura & Alan S Maisel

  2. Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Alison Brann

  3. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA

    Kay-Won Chang

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  1. Marin Nishimura
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  2. Alison Brann
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  3. Kay-Won Chang
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  4. Alan S Maisel
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Correspondence to Alan S Maisel.

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Marin Nishimura, Alison Brann, and Kay-Won Chang each declare no conflicts of interest.

Alan S. Maisel reports receiving research grants from Roche and consulting for Critical Diagnostics.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Biomarkers of Heart Failure

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Nishimura, M., Brann, A., Chang, KW. et al. The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers. Curr Heart Fail Rep 15, 239–249 (2018). https://doi.org/10.1007/s11897-018-0398-4

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