Cardiac troponin assays in the management of heart failure

• Higher cTn concentrations are associated with greater risk of developing HF.
• Higher cTn is associated with higher morbidity and mortality in patients with ADHF and chronic HF.
• Models using both cTn and natriuretic peptides better predict future adverse events.
• High sensitivity cTn assays provide additional prognostic information.
• Studies are needed to evaluate serial cTn monitoring as a tool to guide therapy in HF patients.

Cardiac troponins I and T are established biomarkers of cardiac injury. Testing for either of these two cardiac troponins has long been an essential component of the diagnosis of acute myocardial infarction. In addition, cardiac troponin concentrations after acute myocardial infarction predict future adverse events including development of ischemic heart failure and chronic elevations of cardiac troponin correlate with heart failure severity. These predictions and correlations are particularly obvious when cardiac troponin concentrations are measured using the new high sensitivity cardiac troponin assays. Thus, a growing body of literature suggests that cardiac troponin testing may have important clinical implications for heart failure patients with reduced or preserved ejection fraction. In this review, we explore the prognostic utility of measuring cardiac troponin concentrations in patients with acute or chronic heart failure and in populations at risk of developing heart failure and the relationship between cardiac troponin levels and disease severity. We also summarize the ongoing debates and research on whether serial monitoring of cardiac troponin levels may become a useful tool for guiding therapeutic interventions in patients with heart failure.