Transforming heart disease detection with a new era of laboratory biomarkers

Cardiovascular disease remains the leading cause of death worldwide, responsible for nearly one-third of global mortality. The challenge of diagnosing these conditions early and accurately has long driven innovation in clinical diagnostics. Today, advances in cardiac biomarkers are reshaping how clinicians identify and manage both acute and chronic heart disease.

Dr. Louise Cullen and Dr. James Januzzi reveal how laboratory biomarkers are transforming emergency and long-term cardiac care around the world

High-sensitivity troponin and natriuretic peptides have become central to this shift. These laboratory-based assays are bridging the gap between the bench and the bedside, offering faster, more reliable insights into myocardial injury and heart failure. In a recent SelectScience^® webinar hosted in partnership with Siemens Healthineers, two leading experts explored how these tools are transforming patient care.

During the session, titled From Lab to Life: How Cardiac Biomarkers are Transforming Diagnosis and Prognosis, Dr. Louise Cullen, professor of medicine and emergency physician in Brisbane, and Dr. James Januzzi, professor of medicine at Harvard Medical School and chief scientific officer of the Baim Institute for Clinical Research, shared evidence and strategies for integrating cardiac biomarkers into clinical workflows. The discussion highlighted how these assays can improve diagnostic confidence, efficiency, and prognosis across the continuum of cardiac care.

The evolution of high-sensitivity troponin

Dr. Cullen opened with a perspective from the emergency department, where overcrowding and resource pressures continue to grow. “What is internationally being experienced at the moment through emergency departments is an increase in demand and an increase in pressure,” she said.

With overcrowding directly linked to poorer outcomes¹, improving efficiency in cardiac evaluation has become a pressing need. Chest pain was cited in the webinar as one of the most frequent reasons for emergency visits in developed nations, yet “fewer than 10 percent of patients are ultimately diagnosed with an acute myocardial infarction,” Dr. Cullen noted. This reality underscores the importance for fast, accurate triage to distinguish high-risk patients from those who can be safely discharged.

“If you’re not using a high-sensitivity troponin assay at this point in time, I beg you to go and ask yourself why not,” Dr. Cullen said. Compared with older generations of tests, these assays have “superior analytical performance,” detecting extremely low concentrations of troponin with a coefficient of variation of 10 percent or less at the 99th percentile. This enhanced sensitivity enables clinicians to identify minor myocardial injury that would previously have gone undetected.

“Not only do they allow us to more quickly and accurately diagnose acute myocardial infarction,” she explained, “the use of these assays in healthcare systems is associated with lower one-year mortality.” High-sensitivity assays reduce emergency-department stays, minimize serial blood draws, and support earlier discharge for low-risk patients. They also enable sex-specific reference limits, a key advance for women who are often underdiagnosed due to differing biological baselines.

Dr. Cullen described rapid-assessment strategies now used globally. “With these strategies,” she said, “clinical assessment is key, first and foremost, and ECGs are also vital.” Once patients with clear ECG abnormalities are identified, troponin values guide placement into low-, intermediate-, or high-risk categories.

Validation studies have confirmed the safety and accuracy of these strategies across diverse populations. “From an ED perspective,” she said, “I am most interested in the very high negative predictive value with great confidence to be able to safely send people home.” In a major Australian study, Dr. Cullen’s team found that more than 60 percent of chest-pain patients met low-risk criteria using this approach. “We were able to move them out of the hospital setting back into the community and not requiring further investigation,” she said.

Implementing such protocols requires coordination across disciplines. “Most important is the collaboration, not only between emergency physicians, but our cardiologists, and our lab pathologists as well,” she said. Education, standardized protocols, and continuous monitoring are essential to ensuring that rapid algorithms achieve their intended benefits.

Dr. Cullen also shared findings from an Australian national study examining the transition to high-sensitivity assays across seven hospitals. “We looked at nearly 180,000 patient care episodes,” she said. Compared with hospitals that did not make the change, those adopting high-sensitivity assays saw “a significant reduction in mortality and in major adverse cardiac events,” with the largest benefits observed among women due to the use of sex-specific thresholds.

Troponin as a tool for prognosis

Beyond its diagnostic role, high-sensitivity troponin is proving valuable for long-term risk assessment. “High-sensitivity troponin predicts future cardiovascular events,” Dr. Cullen said, referring to major cohort studies that link even low-level elevations with greater risk of death or heart failure. Because troponin levels respond to interventions such as exercise, blood pressure management, and lipid lowering therapy, they can also serve as indicators of treatment effectiveness. “Troponin is clearly a risk-defining biomarker,” she concluded, “useful in context for both diagnosis and prognosis.”

Dr. Cullen’s presentation led naturally into the second focus of the webinar: the use of natriuretic peptides in diagnosing and managing heart failure, presented by Dr. Januzzi.

Understanding natriuretic peptides

“It’s important to acknowledge that biomarkers are a support to clinical judgment,” Dr. Januzzi began. “They don’t replace clinical judgment necessarily.” Still, he emphasized, few tests have had as significant an impact on heart-failure management as BNP and NT-proBNP.

“Globally, the number of individuals with heart failure continues to grow,” he said. Modern definitions of heart failure now include “evidence for an abnormal natriuretic peptide” alongside symptoms and imaging findings. These peptides, released in response to myocardial stress, act as “counter-regulatory mechanisms for managing heart stress.”

Both BNP and NT-proBNP provide powerful diagnostic and prognostic information. “Natriuretic peptides are cleared by a wide range of tissues,” he said, explaining that while BNP has a shorter half-life, NT-proBNP circulates longer and changes more slowly with therapy.

Elevations, however, are not exclusive to heart failure. “Stress in any situation may cause a rise,” he cautioned, citing arrhythmias, valve disease, pulmonary embolism, and sepsis among other causes. Conversely, “when a person has obesity, it results in lower concentrations” due to suppression of the BNP gene. These nuances, he said, highlight the importance of interpreting results in context.

Diagnostic power and cost savings

Dr. Januzzi highlighted the diagnostic accuracy demonstrated in recent studies. “Individuals with acute heart failure had higher concentrations of NT-proBNP with excellent area under the receiver-operator characteristic curve,” he said of the ICON-RELOADED trial.

In emergency settings, an NT-proBNP rule-out threshold of 300 nanograms per liter offers strong negative predictive value, while age-stratified cutoffs improve diagnostic confidence of ruling-in. “Using an age-stratified approach solidifies the positive predictive value quite substantially,” he explained during the discussion.

Cost-effectiveness analyses further reinforce the case for testing. The use of natriuretic peptides “was not only cost-saving, but resulted in fewer admissions, fewer intensive-care stays, and fewer readmissions,” he said. Measurements at discharge also predict outcomes. “Individuals with substantial reductions in NT-proBNP or BNP during hospitalization have a substantially better prognosis.”

Extending impact beyond hospitalization

In the outpatient setting, natriuretic peptides guide both diagnosis and disease management. “An NT-proBNP less than 125 has excellent negative predictive value,” Dr. Januzzi said. Serial monitoring offers early warning of decompensation. “Those individuals that had a cardiopulmonary event tended to have a higher NT-proBNP, rising weeks to months ahead of the event.” Regular measurement every three months is now recommended in major clinical guidelines. To put a finer point on it, Dr. Januzzi concluded that, “In the past 20 years, natriuretic peptides have gone from being a curiosity to an essential tool in our everyday care.”

A collaborative future for cardiac diagnostics

In their closing discussion, both speakers stressed the importance of teamwork between laboratories and clinicians. “These cardiac biomarkers need a nuanced approach,” Dr. Cullen said. “We’ve got to work collaboratively in this space.” Dr. Januzzi agreed, saying, “…it’s not just the emergency department or cardiology. At this point, it’s also primary care physicians, endocrinologists, and kidney doctors. We really have to be collaborative.”

As the science of cardiac biomarkers continues to advance, their reach now extends far beyond the lab bench. Together, high-sensitivity troponin and natriuretic peptides are redefining how cardiovascular disease is diagnosed, managed, and even prevented, bringing modern cardiac care closer to the goal of precision medicine and improving patient outcomes around the world.

Watch the full webinar on demand to hear directly from Dr. Louise Cullen and Dr. James Januzzi about how cardiac biomarkers are transforming diagnosis and prognosis.

Reference:

1. Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthcare (Basel). 2022 Aug 25;10(9):1625. doi: 10.3390/healthcare10091625. PMID: 36141237; PMCID: PMC9498666.