Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section
Top Cited Papers
Open Access
- 28 June 2012
- journal article
- review article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 33 (18), 2265-2271
- https://doi.org/10.1093/eurheartj/ehs191
Abstract
Cardiac troponin testing is commonly performed in patients with heart failure (HF). Despite being strongly linked to spontaneous (Type I) acute myocardial infarction (MI)—a common cause of acute HF syndromes—it is well recognized that concentrations of circulating troponins above the 99th percentile of a normal population in the context of both acute and chronic HF are highly prevalent, and frequently unrelated to Type I MI. Other mechanism(s) leading to troponin elevation in HF syndromes remain elusive in many cases but prominently includes supply–demand inequity (Type II MI), which may be associated with coronary artery obstruction and endothelial dysfunction, or may occur in the absence of coronary obstruction due to increased oxygen demand related to increased wall tension, anaemia, or other factors provoking subendocardial injury. Non-coronary triggers, such as cellular necrosis, apoptosis, or autophagy in the context of wall stress may explain the troponin release in HF, as can toxic effects of circulating neurohormones, toxins, inflammation, and infiltrative processes, among others. Nonetheless, across a wide spectrum of HF syndromes, when troponin elevation occurs, independent of mechanism, it is strongly predictive of an adverse outcome. Clinicians should be aware of the high frequency of troponin elevation when measuring the marker in patients with HF, should keep in mind the possible causes of this phenomenon, and, independent of a diagnosis of ‘acute MI’, should recognize the considerable ramifications of troponin elevation in this setting.Keywords
This publication has 65 references indexed in Scilit:
- Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart FailureCirculation, 2012
- Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failureEuropean Journal of Heart Failure, 2011
- Serial changes in high‐sensitive troponin I predict outcome in patients with decompensated heart failureEuropean Journal of Heart Failure, 2011
- Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older AdultsJAMA, 2010
- Troponin Elevation in Heart Failure: Prevalence, Mechanisms, and Clinical ImplicationsJournal of the American College of Cardiology, 2010
- Prognostic role of highly sensitive cardiac troponin I in patients with systolic heart failureAmerican Heart Journal, 2010
- 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in AdultsCirculation, 2009
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008‡European Journal of Heart Failure, 2008
- Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial InfarctionEuropean Heart Journal, 2007
- EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of populationEuropean Heart Journal, 2006