Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Abstract

Background and Purpose: Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. Methods: The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. Results: A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. Conclusions: HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.

Plasma cBIN1 Score (CS) Identifies HFrEF and Can Predict Cardiac Hospitalization in Stable Ambulatory Patients

“…High sensitivity troponin release in the absence of coronary hypoperfusion is also a marker of ongoing myocyte injury and necrosis [39][40][41][42][43]. A scientific consensus is that natriuretic peptide and high sensitivity troponins add prognostic information for predicting new-onset HF [44]. Additional promising biomarkers include a family of inflammatory mediators and oxidative stress markers, which participate in the inflammation cascade that leads to tissue injury, remodeling and fibroblast proliferation.…”

Biomarkers in Heart Failure

“…Recently ended STOP-HF (The St Vincent's Screening to Prevent Heart Failure) trial [3] was reported that BNP-based screening was able to reduce the composite endpoint of asymptomatic cardiac dysfunction (regardless to systolic or diastolic) with or without newly diagnosed chronic HFrEF/HFpEF that confirms the immense role of screening NPs and early intervention may prevent HF. More recent evidence suggests that NPs along with the next generation of CV biomarkers could provide added predictive value to drug therapy of HF, which could potentially lower HF-related risk of outcomes [4,5].…”

Biomarkers of Myocardial Stress and Fibrosis for Clinical Outcomes Assessment in Post Myocardial Infarction Heart Failure Patients

“…Для предсказания вероятно-сти наступления неблагоприятного сердечно-сосудис того события использовалась логистическая как функциональный класс (ФК) New York Heart Association (NYHA), фракция выброса левого желу-дочка (ФВ ЛЖ), рутинные лабораторные показатели, не могут полностью оценить риск неблагоприятных клинических исходов и определить индивидуальный прогноз у пациентов с СН. Стратификацию риска улучшает применение биомаркеров, отражающих различные механизмы формирования и развития синдрома СН [1][2][3].…”

“…Их повышенная секреция связана с растяжением кардио-миоцитов, однако на сывороточные концентрации оказывают влияние и другие факторы, включая воз-раст, почечную функцию, анемию. Кроме того, НП раскрывают не все патогенетические аспекты СН, что актуализирует поиск новых биомаркеров, облада-ющих как дополнительным, так и самостоятельным прогностическим значением [3,6].…”

“…Применение в мультимаркерном анализе двух или более биомаркеров из различных патогенетических классов позволяет получить дополнительную прогно-стическую информацию и представляется рацио-нальной и надежной современной стратегией риск-стратификации пациентов с СН, требующих наибо-лее пристального внимания [1,3,6]. Большинство мультимаркерных подходов включает добавление новых перспективных биомаркеров к хорошо изучен-ным НП [2,14].…”