Use of cardiac troponin in patients with heart failure

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.