Cardiac biomarkers: new tools for heart failure management

Abstract

The last decade has seen exciting advances in the field of biomarkers used in managing patients with heart failure (HF). Biomarker research has broadened our knowledge base, shedding more light on the underlying pathophysiological mechanisms occurring in patients with both acute and chronic HF. The criterion required by an ideal cardiovascular biomarker has been progressively changing to an era of sensitive assays that can be used to guide treatment. Recent technological advances have made it possible to rapidly measure even minute amounts of these proteins by means of higher sensitivity assays. With a high prevalence of comorbidities associated with HF, an integrated approach utilizing multiple biomarkers have shown promise in predicting mortality, better risk stratification and reducing re-hospitalizations, thus lowering health-care costs. This review provides a brief insight into recent advances in the field of biomarkers currently used in the diagnosis and prognosis of patients with acute and chronic HF.

Keywords: Decompensated heart failure; cardiac myocyte; glomerular filtration rate; natriuretic peptides.

Figure 1

Schematic representation of the release of various biomarkers from organs in patients with heart failure. Increased ventricular wall stretch is the primary inciting event causing a cascade of biomarker release which can be measured to monitor disease severity and ongoing myocardial insult. The growing body of research has shown that in heart failure patients, complex underlying pathophysiological processes can be better understood by monitoring biomarker activity. BNP: B-Type Natriuretic Peptide; NT-proBNP: Amino Terminal Natriuretic Peptide; MR-proANP: Mid-regional A-type Natriuretic Peptide; GDF-15: Growth differentiation factor 15; NGAL: Neutrophil gelatinase associated lipocalin; IL 6: Interleukin 6; TNF-α: Tumor necrosis factor alpha; CRP: C-Reactive protein; RAAS: Renin-angiotensin-aldosterone system