Angiotensin-converting enzyme (ACE) inhibitors are the symptomatic heart failure therapy of choice and are used more frequently in patients with high hs-cTnT levels [3]. Current evidence on hs-cTnT in CS is limited by small single-center studies [4,5,7], inconsistent measurement protocols, and a lack of consensus on interpreting longitudinal trends [8]. This evidence concerns the gene TNNT2 and Cowden syndrome 1.