High-Sensitive Cardiac Troponin for Prediction of Clinical Heart Failure
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Article, see p 1494
Heart failure (HF) prevalence continues to rise, and projections show that in the next 2 decades, ≈45% more HF cases will occur, with a mortality rate remaining as high as 50% within 5 years of diagnosis and high healthcare costs. Hence, there is an unmet need to apply successful preventive programs and reduce HF incidence. Also, according to current guidelines, an effective HF preventive program requires adequately targeting the preclinical stages of the disease, including risk factors for HF, such as hypertension, diabetes mellitus, renal dysfunction, coronary artery disease, and abnormalities of cardiac structure/function associated with HF, such as left ventricular (LV) hypertrophy and low LV ejection fraction.1
Recently, efforts to better identify subjects at the highest risk were undertaken. Different biomarkers have been studied for this purpose. Although many candidate biomarkers have been described, few have made the difficult translation from initial promise to clinical application.2
Among biomarkers, high-sensitivity cardiac troponin (hs-cTn) can detect small amounts of myocyte injury. Using high-sensitivity assays, detectable levels of cardiac troponin have been demonstrated among apparently healthy individuals in the general population, including stage A HF, as well as in asymptomatic individuals with stable cardiovascular disease, stage B HF, with a prevalence of detectable levels, ranging from 60% to 80% in asymptomatic individuals.3,4
Hs-cTn elevation may be caused by multiple mechanisms, in addition to myocardial necrosis. These include cardiomyocyte damage from inflammatory cytokines or oxidative stress, apoptosis, increased cell membrane …