Novel biomarkers for heart failure

Abstract

Heart failure (HF) has proven to be a major burden on the health system. The continuing prevalence of the condition and its rising associated costs and care, has amplified the need for earlier diagnosis, better risk stratification and cost-effective treatment to cut rates of hospitalization. Biomarkers seem poised to undertake such tasks, with biomarker management of patients with HF quickly evolving over the past several years. Biomarker guided diagnosis and treatment has become vital, especially during the acute setting in which the majority of patients with HF, were initially present. An adequate assessment of risk requires a multi-marker approach to a given HF patient. Established markers including brain natriuretic peptide and NT-proBNP are a significant clinical aid to physicians, though their utility is limited. In the past few years, momentous effort has been put into the discovery of new biomarkers. These endeavors have led to the emergence of several capable and promising biomarkers for HF management including troponins, mid-regional pro-adrenomedullin, GDF-15, C-reactive protein, Galectin-3, IL-6, ST-2, neutrophil gelatinase-associated lipocalin, copeptin and procalcitonin. This review will offer an insight into the novel biomarkers considered as the cutting-edge in the diagnosis and management of HF.

Keywords::

• acute decompensated heart failure
• acute kidney injury
• Galectin-3
• guided therapy
• high sensitivity troponins
• natriuretic peptides

Financial & competing interests disclosure

Al Maisel is a consultant for Alere, Critical Diagnostics, EFG and has received research support from Alere, Abbott, Nanosphere, Brahms-thermofisher and Novartis. The authors have no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Heart failure (HF) is a major concern for the developing world. It results from any structural or functional cardiac condition that impairs the ability of ventricle to fill properly or pump blood to the body.

• • Despite advances in medical science, the diagnosis and management of HF can be a daunting task in an acute setting.

• • Projections to the year 2020 predict that deaths from cardiovascular diseases will exceed deaths from infectious and parasitic diseases for the first time in all world regions except sub-Saharan Africa, leading to a global cardiovascular disease epidemic.

• • Biomarkers have provided a unique platform to look into the pathophysiology of heart failure and aided in the appropriate management.

• • Natriuretic peptides have been the most studied biomarkers in HF diagnosis and management, and have proved to be cost effective.

• • Being a potent vasodilator and a regulator of salt and water homeostasis, plasma brain natriuretic peptide (BNP) concentrations are increased during myocardial wall stretch and serves as a good indicator of prognostic outcome.

• • Besides BNP, NT-proBNP has also been studied extensively and is believed to be equivalent for diagnostic evaluation of patients with suspected HF.

• • There are some limitations to the use of these conventional biomarkers such as obesity, renal insufficiency, shock and atrial arrhythmias.

• • New biomarkers that have emerged in the past decade and have a plausible link with HF pathophysiology include high sensitivity troponin (HsTnI) (marker of myocyte injury), mid-regional pro-adrenomedullin (MR-proADM) & mid-regional pro-atrial natriuretic peptide (MR-proANP) (markers of myocyte strain), neutrophil gelatinase-associated lipocalin (NGAL) (marker of kidney injury), procalcitonin (marker of sepsis), Galectin-3 (Gel-3), ST-2 and GDF-15 (markers of myocyte remodeling), IL-6 and C-reactive protein (CRP) (markers of inflammation) and copeptin (marker of neurohormonal activation).

• • The discovery of these biomarkers will give clinicians a unique glimpse into the molecular mechanisms of HF and ultimately help them in heart failure management.

• • Future trials using multimarker-guided approaches and involving more patients with longer follow-ups and end points such as cardiovascular death and all cause mortality are required to add prognostic value and aid in risk stratification.

Notes