The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years. Representing a major burden on health systems, acute HF has increased the need for earlier diagnosis, better risk stratification, and cost-effective treatment to reduce rates of hospitalization. Biomarker-guided diagnosis and treatment have become essential, especially in the acute setting to which the majority of the patients with acute HF initially present. Studies clearly demonstrate the complexity of these patients, who commonly have multiple comorbidities necessitating an integrative approach. Several groundbreaking studies conducted in the past decade have demonstrated how biomarkers, individually or in combination, can outperform conventional laboratory tests used in the emergency department as well as in hospitalized patients with acute HF. In this Review, we will provide an update on biomarkers considered state of the art in the diagnosis and management of patients with acute HF.

Biomarker testing in patients with heart failure (HF) is rapidly expanding. With high-quality research indicating its diagnostic and prognostic capabilities, biomarkers are excellent adjuncts to manage patients with HF. Their superiority lies mainly in their reflection of ongoing pathophysiological events at a cellular level. Monitoring biomarker levels has been shown to provide incremental information on the progression of disease, thus allowing to better tailor treatment and management. Several biomarkers have gained attention in the past decade and continuing research demonstrates the specificity of each biomarker to be used on its own or in combination to improve diagnostic accuracy. This review will provide an insight into the role of such biomarkers, which are widely studied in the setting of HF so as to delineate their role in diagnosing, prognosticating, and titrating HF therapy.

Heart failure is a major burden to the health care system in terms of not only cost, but also morbidity and mortality. Appropriate use of biomarkers is critically important to allow rapid identification and optimal risk stratification and management of patients with both acute and chronic heart failure. This review will discuss the biomarkers that have the most diagnostic, prognostic, and therapeutic value in patients with heart failure. We will discuss established biomarkers such as natriuretic peptides as well as emerging biomarkers reflective of myocyte stress, myocyte injury, extracellular matrix injury, and both neurohormonal and cardio-renal physiology.

The authors believe that NGAL should be used as a clinical diagnostic tool to predict outcomes in patients with CVD. Growing evidence has illustrated the biological role that neutrophils, such as NGAL, play in inflammation and atherosclerosis. Further studies are needed to determine NGAL's stability in serum and urine, and to substantiate its widespread use, but there are expanding possibilities for this biomarker in clinical practice.

AIM:The aim of the study is to compare quetiapine with placebo along with oral naltrexone in the treatment of opioid dependent patients. We conducted the study as opioid dependence is steadily increasing in this area and more research is needed to prevent relapse after opioid detoxification. SETTINGS AND DESIGN: It is a double blind placebo controlled , randomized study that was conducted in department of psychiatry, de addiction unit (Sri Guru Ram Das Institute of Medical Sciences & Research, Sri Amritsar) over one year time period. All the patients who were taken in the study had a confirmed diagnosis of opioid dependence as per ICD 10 criteria. MATERIAL AND METHOD: It is a double blind, placebo controlled, randomized study. A total of 217 subjects were admitted over year, out of which 164 were screened as 53 subjects refused to participate. Out of 164 randomization of 152 patient was done and two groups (1&2) were made. . During detoxification, opioids were given to both groups and stopped after 1-2 weeks. Then all patients were started on Naltrexone 50 mg/day. Group 1 (n=73) received naltrexone (50mg/day) plus quetiapine (50-200mg/day), while group 2 (n=79) received naltrexone (50mg/day) plus placebo (multivitamin) for next 26 weeks. Our primary efficacy measures were relapse rate and percent days of abstinence. Two groups were compared with the help of percentage method and independent t test done. RESULTS: Relapse rate in placebo group was almost twice to that of Quetiapine group. In group 1, 24 subjects (32.87%) had relapsed by the end of 6 months as compared to 56 subjects (70.88%) in group 2. Percent days of abstinence in Quetiapine group were significantly higher as compared to placebo group. DISCUSSION: Our study shows significant advantages in using Quetiapine along with Naltrexone to decrease relapse rate and increase percent days of abstinence after inpatient detoxification.

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High mortality, morbility and hospitalization as a result of acute heart failure (AHF) represents an increasing public health dilemma. A prompt and appropriate therapeutic approach in the management of AHF has been demonstrated to be of great importance in reducing patient mortality and in-hospital length of stay. As consequence, at the moment of patient presentation, it is of great importance to make a fast and accurate diagnosis and risk stratification. Although an global clinical evaluation is mandatory, in some cases the signs and instrumental findings are not sufficient for a complete patient's diagnosis and risk stratifications. Multiple studies demonstrated that biomarkers assessment plus clinical judgement provide additional diagnostic and prognostic value in AHF patients. Moreover, data from the literature demonstrated the utility of a multimarkers approach in patients with heart failure in order to ameliorate diagnostic and prognostic accuracy. This paper is dedicated to addressing the actual state of the art on the utility in the management of acute heart failure of the following biomarkers: natriuretic peptides, procalcitonin, MRproADM, copeptine, neutrophil gelatinase associated lipocalin and galectin 3.

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. In the past decade, biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have proved extremely useful in determining whether acute dyspnoea has a cardiac aetiology. In addition, recent trials have demonstrated the use of natriuretic peptides in inpatient and outpatient prognosis, as well as in titrating medications in outpatients with chronic heart failure to prevent acute heart failure hospitalizations. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, mid-regional proatrial natriuretic peptide, troponin, ST2, and neutrophil gelatinase-associated lipocalin.