Significance of Circulating Troponins in Heart Failure

B iomarkers serve 2 potential roles: They provide insight into the pathophysiology of disease, and they aid clinical decision making by clarifying diagnosis, prognosis, or response to therapy. Fulfillment of one role does not ensure fulfillment of the other. For instance, some biomarkers associated with disease progression turn out to provide little incremental clinical value. Thus, studies like the one by Latini and colleagues 1 in this issue of Circulation are valuable because they couple investigation of a biologically interesting association, in this case the link between circulating troponins and heart failure (HF), with a rigorous assessment of clinical utility. The following commentary focuses on 2 questions raised by the study by Latini et al. First, what is the pathophysiological significance of circulating troponins in HF? Second, should we be measuring cardiac troponins in chronic HF patients?