Biomarkers for the diagnosis and management of heart failure

Abstract

Heart failure (HF) is a significant cause of morbidity and mortality worldwide. Circulating biomarkers reflecting pathophysiological pathways involved in HF development and progression may assist clinicians in early diagnosis and management of HF patients. Natriuretic peptides (NPs) are cardioprotective hormones released by cardiomyocytes in response to pressure or volume overload. The roles of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification in HF have been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. On the contrary, conflicting evidence exists on the role of NPs as a guide to HF therapy. Among the other biomarkers, high-sensitivity troponins and soluble suppression of tumorigenesis-2 are the most promising biomarkers for risk stratification, with independent value to NPs. Other biomarkers evaluated as predictors of adverse outcome are galectin-3, growth differentiation factor 15, mid-regional pro-adrenomedullin, and makers of renal dysfunction. Multi-marker scores and genomic, transcriptomic, proteomic, and metabolomic analyses could further refine HF management.

Keywords: Biomarkers; Heart failure; Inflammation; Natriuretic peptides; SST2; Troponin.

Fig. 1

Processing of type B natriuretic peptides and their role as biomarkers in heart failure. BNP B-type natriuretic peptide, NT-proBNP N-terminal pro-B-type natriuretic peptide

Fig. 2

Main pathophysiological pathways involved in heart failure and their most representative biomarkers. BNP brain natriuretic peptide, CA125 cancer antigen 125, CRP C-reactive protein, FGF-23 fibroblast growth factor-23, fT3 triiodothyronine, GDF15 growth differentiation factor, GFR glomerular filtration rate, hs-TnI/T high sensitivity-troponin I/T, KIM-1 kidney injury molecule-1, MMP matrix metalloproteases, MPO myeloperoxidase, MR-proADM mid-regional pro-adrenomedullin, MR-proANP mid-regional pro-atrial natriuretic peptide, NAG N-acetyl-β-(D)-glucosaminidase, NGAL neutrophil gelatinase-associated lipocalin, NT-proBNP N-terminal pro-B-type natriuretic peptide, PRA plasma renin activity, sST2 soluble suppression of tumorigenesis-2, TIMP tissue inhibitor of metalloproteinase, TNF-α tumor necrosis factor alpha