Troponin in non-ischaemic dilated cardiomyopathy

Non-ischaemic dilated cardiomyopathy (DCM) is a disease characterised by progressive left ventricular remodelling and dysfunction. DCM represents a major cause of morbidity and mortality. Cardiac troponins are sensitive biohumoral markers of myocyte injury that are used for diagnostic purposes in acute coronary syndromes but that are also detected in DCM. Several pathophysiological factors (wall stress, neurohormonal activation, inflammation, metabolic dysfunction, microvascular ischaemia) have been advocated to explain subtle ongoing necrosis in DCM. In particular, new ultrasensitive assays expand the detection range toward physiological cardiac troponin levels, allowing accurate biohumoral characterisation of myocardial remodelling from the early stages of DCM. Moreover, several clinical studies have demonstrated that increased cardiac troponin plasma levels are associated with worse prognosis and that further increases in cardiac troponin over time contribute to additional risk. Serial plasma cardiac troponin evaluation represents an accurate marker of disease evolution and risk stratification in DCM, identifying high-risk patients who need strict follow-up and enhanced therapeutic effort. © TOUCH BRIEFINGS 2011.