Heart failure risk estimation based on novel biomarkers

ABSTRACT

Introduction: Despite advances in medical care, heart failure (HF)-associated morbidity and mortality remains high. Consequently, there is increased effort to find better ways for predicting, screening, and prognosticating HF in order to facilitate effective primary and secondary prevention.

Areas covered: In this review, we describe the various biomarkers associated with different etiologic pathways implicated in HF, and discuss their roles in screening, diagnosing, prognosticating and predicting HF. We explore the emerging role of multi-omic approaches. We performed electronic searches in databases (PubMed and Google Scholar) through December 2020, using the following key terms: biomarker, novel, heart failure, risk, prediction, and estimation.

Circulating BNP and troponin concentrations have been established in clinical care as key biomarkers for diagnosing and prognosticating HF. Emerging biomarkers (such as galectin-3 and ST-2) have gained further recognition for use in evaluating prognosis of HF patients. Promising biomarkers that are yet to be part of clinical recommendations include biomarkers of cardiorenal disease.

Expert opinion: Increasing recognition of the complex and interdependent nature of pathophysiological pathways of HF has led to the application of multi-marker approaches including multi-omic high throughput assays. These newer approaches have the potential for new therapeutic discoveries and improving precision medicine in HF.

KEYWORDS:

• Biomarker
• heart failure
• prediction
• prognosis
• screening
• multi-marker
• omics

Article highlights

• Heart failure remains a leading cause of morbidity and mortality. Therefore, there is a need to optimize prediction, screening, and prognostication of HF to facilitate effective primary and secondary prevention.

• Biomarkers play an important role in this context. Some of these circulating biomarkers, e.g. B-type natriuretic peptide (BNP) and Troponin are well established, and are currently being used in clinical practice for diagnostic purposes and monitoring of HF.

• Guidelines have also endorsed emerging circulating biomarkers such as Galectin-3 and ST-2 for use in clinical practice to inform clinicians about HF prognosis. While other biomarkers that are at the intersection of cardiorenal disease (e.g. Cystatin C, NGAL, KIM-1) are being studied extensively.

• Studies using genomic, proteomic, and metabolomic biomarkers show promising initial results, and will enhance our mechanistic and molecular understanding of HF as a heterogeneous syndrome.

• OMICs science that is amplified by multi-omic and transomic approaches has the potential for identifying new therapeutic targets in HF

• Digital biomarkers are another class of biomarkers, whose role in the management of HF patients remains to be defined.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The Framingham Heart Study (FHS) acknowledges the support of Contracts [NO1-HC-25195, HHSN268201500001I and 75N92019D00031] from the National Heart, Lung and Blood Institute. Dr. Vasan is supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine.This work was also supported by the National Heart, Lung and Blood Institute grants [1R38HL143584]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.