Future directions

Fig. 7. Risk of death in patients with CHF stratified by cTnl and BNP results. (From ref. 14.)

marker of necrosis in combination with a biomarker of hemodynamic stress was described in the previous section. The concept of a multimarker approach in heart failure is likely to guide future research and clinical applications.

The level of any marker protein in the circulation depends on the analytic performance of the assay used for its detection. Initial studies on cardiac troponins in heart failure documented that both cTnl and cTnT could be measured with currently available immunoassays and, in some patients, revealed a magnitude of increase that was similar to that observed in acute myocardial infarction (11,12,15,20). Moreover, the development of a more sensitive immunoassay allowed the detection of cTnl in a greater number of patients. These observations suggest that improved analytic performance will lead to better clinical characterization of the disease process in patients with CHF (11) and support the value of ongoing work focused on the development and clinical validation of more sensitive assays for troponin. Finally, before biomarkers of necrosis are applied routinely in the evaluation of patients with heart failure, prospective studies defining the appropriate therapeutic response are necessary. On the basis of presently available data, it is reasonable to consider more aggressive treatment strategies in line with their higher risk for patients with increased levels of cardiac troponin.

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