Beyond cardiac troponin: recent advances in the development of alternative biomarkers for cardiovascular disease

Biomarkers complement clinical assessment, electrocardiogram and cardiac imaging in the diagnosis, risk stratification, triage and management of patients with suspected acute cardiovascular diseases. While there is broad consensus that cardiac troponin is the preferred biomarker in clinical practice for the detection of cardiomyocyte damage, the role of alternative biomarkers is less clear. In fact, despite high quality basic and clinical research by hundreds of groups worldwide, only a single new alternative cardiovascular biomarker (natriuretic peptides) has managed to achieve widespread clinical acceptance and inclusion in contemporary clinical practice guidelines in the last decade. This review aims to discuss the remaining unmet needs (and hence opportunities for new biomarkers) in two major clinical areas: early diagnosis of acute myocardial infarction; and early diagnosis and management of acute heart failure, and to evaluate in detail selected alternative biomarkers and recent insights gained from measuring novel biomarkers in large randomized treatment studies in patients with stable coronary artery disease, a setting in which alternative biomarkers may play a more prominent role in the future.