Current Heart Failure Reports

, Volume 15, Issue 4, pp 239–249 | Cite as

The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers

  • Marin Nishimura
  • Alison Brann
  • Kay-Won Chang
  • Alan S MaiselEmail author
Biomarkers of Heart Failure (W Tang and J Grodin, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Biomarkers of Heart Failure


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. 1.

    A biomarker value should never be used without clinical context

  2. 2.

    Serial sampling of biomarkers is often helpful

  3. 3.

    Panels of biomarkers may be valuable



Heart failure Cardiac biomarkers Non-cardiac pathologies 


Compliance with Ethical Standards

Conflict of Interest

Marin Nishimura, Alison Brann, and Kay-Won Chang each declare no conflicts of interest.

Alan S. Maisel reports receiving research grants from Roche and consulting for Critical Diagnostics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marin Nishimura
    • 1
  • Alison Brann
    • 2
  • Kay-Won Chang
    • 3
  • Alan S Maisel
    • 1
    Email author
  1. 1.Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaUSA
  2. 2.Department of MedicineUniversity of California, San DiegoLa JollaUSA
  3. 3.Cedars-Sinai Heart InstituteCedars-Sinai Medical CenterLos AngelesUSA

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