Novel Biomarkers in Heart Failure: New Insight in Pathophysiology and Clinical Perspective

Abstract

Heart failure (HF) is a complex clinical syndrome with a huge social burden in terms of cost, morbidity, and mortality. Brain natriuretic peptide (BNP) appears to be the gold standard in supporting the daily clinical management of patients with HF. Novel biomarkers may supplement BNP to improve the understanding of this complex disease process and, possibly, to personalize care for the different phenotypes, in order to ameliorate prognosis. In this review, we will examine some of the most promising novel biomarkers in HF. Inflammation plays a pivotal role in the genesis and progression of HF and, therefore, several candidate molecules have been investigated in recent years for diagnosis, prognosis, and therapy monitoring. Noncoding RNAs are attractive as biomarkers and their potential clinical applications may be feasible in the era of personalized medicine. Given the complex pathophysiology of HF, it is reasonable to expect that the future of biomarkers lies in the application of precision medicine, through wider testing panels and "omics" technologies, to further improve HF care delivery.

Keywords: biomarker; fibrosis; heart failure; inflammation; noncoding RNA.

Figure 1

Pathophysiological pathways in heart failure and involved biomarkers. sST2 = soluble source of tumorogenesis-2; Gal-3 = galectin-3; PICP = serum carboxy-terminal propeptide of procollagen type I; PIIINP = serum amino-terminal propeptide of procollagen type III; CITP = serum collagen type I telopeptide; ET-1 = endothelin-1; MPO= Myeloperoxidase; GDF15 = Growth-differentiation factor-15; s-FLC = serum free light chain; ADM = adrenomedullin.