This review describes the pathophysiological and histopathological rationale for using the cardiac isoforms of troponin T and troponin I in congestive heart failure (CHF). It also focuses on the potential clinical usefulness of new generation highly sensitive and specific cardiac troponin assays with respect to histological monitoring, risk stratification and therapeutic follow-up of patients with CHF. The availability of more powerful analytical tools for these highly specific markers of myocardial injury offers a unique opportunity to expand the field of their application and to explore new disease processes. Because cardiac troponin T and cardiac troponin I provide useful clinical information unavailable through other diagnostic techniques, they appear as promising biochemical markers in patients with CHF.