High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease

Abstract

Biomarkers are important prognostic tools in various cardiovascular conditions, including coronary artery disease and heart failure. Although their utility in cardiac electrophysiology (EP) is less established, biomarkers may guide EP clinical practice by identifying patients at risk for developing arrhythmias and their complications, in addition to augmenting therapeutic decisions by targeting appropriate pharmacologic and interventional therapies to patients who may benefit most. In this review, we focus on the prognostic role of high-sensitivity cardiac troponin (hs-cTn) assays—which detect subclinical cardiac myocyte damage—in cardiac arrhythmias and their sequelae. We review the current literature on hs-cTn and its impact on various arrhythmia disease states and also provide suggestions for future research in this field. In conclusion, although the utility of hs-cTn assays remains at an investigational stage in cardiac EP, studies to date have suggested value as a prognostic biomarker in atrial fibrillation and as a screening marker for patients at high risk of sudden cardiac death (both in the general population and among those with hypertrophic cardiomyopathy).

Single‐Molecule Counting of High‐Sensitivity Troponin I in Patients Referred for Diagnostic Angiography: Results From the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) Study

“…This detection of hsTn elevation in those without MI has led to some consternation about ambiguity regarding the meaning of such a situation and has led to the increased use of terms such as myocardial “injury” to explain this finding; better definition of the description of patients without MI that have higher hsTn would be of use. Beyond its diagnostic use, hsTn is also recognized as a prognostic biomarker in various cardiac diseases . It remains unclear, however, how this prognostic value varies based on presence and severity of CAD; few studies have examined the prognostic utility of hsTn in patients with varying magnitude of atherosclerotic disease, in part because of a lack of well‐defined coronary anatomy in these trials.…”

“…Beyond its diagnostic use, hsTn is also recognized as a prognostic biomarker in various cardiac diseases. 8,9 It remains unclear, however, how this prognostic value varies based on presence and severity of CAD; few studies have examined the prognostic utility of hsTn in patients with varying magnitude of atherosclerotic disease, [10][11][12] in part because of a lack of well-defined coronary anatomy in these trials.…”

Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

“…In this context, it has recently been hypothesized that biomarkers, and hs-cTnT in particular, may be used as a "gateway" to perform LGE CMR imaging. 7,8 A strategy based on easily obtainable characteristics that would alter the pretest likelihood of extensive LGE before CMR imaging would increase efficacious use of LGE CMR imaging for SCD risk stratification in HC. 7,8 This may especially be valuable for institutions with limited resources to perform CMR imaging.…”

“…5 As extensive LGE (15% of left ventricular [LV] mass) is only seen in about 10%, 6 a strategy based on easily obtainable characteristics that would alter the pretest likelihood, would be a more cost-effective approach than routine LGE cardiovascular magnetic resonance (CMR) imaging. 7,8 In addition to various clinical variables (e.g., LV mass, wall thickness, and nonsustained ventricular tachycardia [NSVT] 9À11 ) biomarkers like cardiac troponin, natriuretic peptides, and markers of collagen turnover have repeatedly been associated with LGE in HC. 12À19 In the previously mentioned clinical context, we aimed to identify predictors of extensive LGE between routinely assessed clinical variables and a broad panel of biomarkers in nonhigh risk HC patients.…”

Short-term effects of Finnish sauna bathing on blood-based markers of cardiovascular function in non-naive sauna users

“…Compared with the older troponin assays, hs-troponin I assays improve the speed of diagnosis and are well-suited for detecting sub-clinical cardiac structural abnormalities [50, 51]. High-sensitivity cardiac troponins have also been suggested to be prognostic biomarkers for cardiovascular events in normal- and high-risk general populations [52]. The minor changes in levels of these markers could be due to the short-term nature of the sauna exposure (only 30 min).…”