The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers.
PURPOSE OF REVIEW
Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves-without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used.


RECENT FINDINGS
High-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays. In the realm of the natriuretic peptides, studies demonstrated states of natriuretic peptide deficiency in obesity and in subjects of African-American race. Regardless, BNP and NT-proBNP both retained prognostic utilities across a variety of comorbid conditions. We are rapidly gaining clinical evidence with use of soluble ST2 and procalcitonin levels in management of cardiac disease states. In order to get the most utility from their measurement, one must be aware of non-cardiac pathologies that may affect the levels of biomarkers as although many of these are actually true values, they may not represent the disease we are trying to delineate. A few take-home points are as follows: 1. A biomarker value should never be used without clinical context 2. Serial sampling of biomarkers is often helpful 3. Panels of biomarkers may be valuable.
['Nishimura|Marin|M|', 'Brann|Alison|A|', 'Chang|Kay-Won|KW|', 'Maisel|Alan S|AS|']
D015415:Biomarkers D006333:Heart Failure D006801:Humans D020097:Natriuretic Peptide, Brain D009765:Obesity D010446:Peptide Fragments D011379:Prognosis D051437:Renal Insufficiency D018570:Risk Assessment D012307:Risk Factors D020521:Stroke D014336:Troponin
Non-cardiac pathologies Cardiac biomarkers Heart failure