Biomarkers in acute heart failure—state of the art

Abstract

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.

Novel heart failure biomarkers: why do we fail to exploit their potential?

“…PCT, the prohormone of calcitonin, is secreted by different types of cells from numerous organs in response to proinflammatory stimulation. PCT levels are strongly elevated in bacterial infections and it is an early marker for systemic inflammation, infection, and sepsis; potentially it could be used to monitor patients and guide antibiotic therapy [135]. The half-life of PCT is about 24 h, and the molecule is stable both in vivo and in vitro [136].…”

“…The half-life of PCT is about 24 h, and the molecule is stable both in vivo and in vitro [136]. PCT was originally postulated to be a proxy for unrecognized infection in acute HF [135]. Based on the BACH (Biomarkers in Acute Heart Failure) trial, PCT was also included in the ESC-HF guidelines for the potential assessment of acute HF patients with suspected coexisting infection, particularly for the differential diagnosis of pneumonia and to guide antibiotic therapy [137].…”

Serum Irisin Predicts Mortality Risk in Acute Heart Failure Patients

“…AHF has a high mortality and always requires immediate medical attention and urgent therapy [1-3]. Identification of novel prognostic biomarkers for AHF long-term mortality risk will help make appropriate management decision and improve clinical therapy for patients [5, 6]. …”

Biomarkers in Heart Failure

“…To establish diagnostic, therapeutic, and prognostic strategies, the identification of reliable biomarkers for heart failure is necessary. 1,2) Although a number of biomarkers have been developed, the ideal biomarkers should meet certain criteria: 1) non-invasive sample collection, 2) a high degree of sensitivity and specificity, 3) able to detect the disease at an early stage, 4) sensitivity high enough to reflect relevant changes in disease conditions, 5) a long halflife within the sample, 6) rapid measurement system responding to clinical needs, and 7) low cost. 3,4) In this article, the focus will be on the recent advances in cardiac and non-cardiac biomarkers of heart failure and their appropriate use in clinical practice.…”