Biomarkers in acute heart failure (original) (raw)
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Biomarkers for Diagnosis and Prognosis of Acute Heart Failure
Current Emergency and Hospital Medicine Reports, 2013
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.
New biomarkers and heart failure
Cor et Vasa, 2013
Novel cardiac biomarker ST2 Galectin Copeptin Mid-regional fragment of proadrenomedullin a b s t r a c t Heart failure is a major health problem with an increasing incidence and prevalence of the disease. The role of both established natriuretic peptides: B-type natriuretic peptide (BNP) and N-terminal prohormone pro-brain natriuretic peptide (NT-proBNP) in acute and chronic heart failure (HF) has been intensively studied. Its testing is routine in clinical practice for diagnosis and prognosis in HF. However, increased clarification and understanding of the interplay in the pathophysiology of HF revealed several new potential cardiac biomarkers. These novel biomarkers soluble ST2, galectin, copeptin and, midregional fragment of pro-adrenomedullin (MR-proADM) may aid in the diagnostic and prognostic evaluation of acute and chronic heart failure.
Circulation, 2017
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. 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 Associat...
Natriuretic peptides and NGAL in heart failure: Does a link exist?
Clinica Chimica Acta, 2012
In recent years there has been growing interest in the development of new diagnostic tools and particularly in laboratory tests for the identification of heart failure (HF) patients. Because of the rise in HF occurrence, it is necessary to use simple and reliable method to recognize those patients at risk before the onset of the clinical symptoms. To date HF diagnosis remains difficult: its symptoms and signs are often non specific as well as being poor sensitive indicators for HF severity. Throughout the last 10 years published literature has highlighted a boom in the use of biomarkers for HF. Both B-type and N-terminal pro-B-type natriuretic peptides have demonstrated specific role in heart failure diagnosis, as well as risk assessment. A single determination of BNP at any time during the development of chronic heart failure (CHF) provides a clinically useful tool to establish the outcome. Renal dysfunction is often associated with heart failure and predicts adverse clinical outcomes. Many studies have recently suggested the clinical use of serum neutrophil gelatinase-associated lipocalin (NGAL) levels in patients admitted to the hospital for acute HF can be used to estimate the risk of early worsening renal function. This could be potentially applied in clinical practice for early identification of renal dysfunction development in patients with HF. NGAL levels appear also to predict renal dysfunction in patients with chronic HF and preserved renal function. For all these reasons, BNP and NGAL are two emerging tools useful for diagnosis and prognosis in HF. The combination of two laboratory biomarkers could potentially identify patients with more elevated risks of both cardiac hemodynamic impairment and kidney dysfunction.
Natriuretic Peptide Testing for Predicting Adverse Events Following Heart Failure Hospitalization
Congestive Heart Failure, 2012
Concentrations of both B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) are useful for diagnostic evaluation of patients with acute decompensated heart failure (ADHF), providing important information regarding presence and severity of heart failure. In addition, levels of both BNP and NT-proBNP are strongly prognostic for adverse outcomes in this setting. While values for BNP and NT-proBNP at hospital admission predict impending risk for adverse outcome, their measurement following HF treatment provides incremental prognostic information, even more accurately identifying patients at highest risk for death or rehospitalization in the short term. Thus, changes in BNP or NT-proBNP following treatment should be considered an important part of the predischarge decision making for patients hospitalized with ADHF.
Circulation, 2004
We read with interest the viewpoint of Dr Milton Packer in a recent editorial 1 accompanying a study examining the behavior of B-type natriuretic peptides in outpatients with congestive heart failure (CHF). 2 Dr Packer 1 suggested that B-type natriuretic peptides (BNPs) have not been shown to "improve upon the information derived from the patient-physician interaction" (p 2951). We disagree, citing data from the BNP (Breathing Not Properly) Multinational Study, 3 in which the results of the results of BNP testing were superior to clinical judgment for the detection of CHF among patients presenting in an urgent fashion. Similar results are now pending for NT-proBNP.
ANMCO/ELAS/SIBioC Consensus Document: biomarkers in heart failure
European heart journal supplements : journal of the European Society of Cardiology, 2017
Biomarkers have dramatically impacted the way heart failure (HF) patients are evaluated and managed. A biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological or pathogenic processes, or pharmacological responses to a therapeutic intervention. Natriuretic peptides [B-type natriuretic peptide (BNP) and N-terminal proBNP] are the gold standard biomarkers in determining the diagnosis and prognosis of HF, and a natriuretic peptide-guided HF management looks promising. In the last few years, an array of additional biomarkers has emerged, each reflecting different pathophysiological processes in the development and progression of HF: myocardial insult, inflammation, fibrosis, and remodelling, but their role in the clinical care of the patient is still partially defined and more studies are needed before to be well validated. Moreover, several new biomarkers have the potential to identify patients with early renal dysfunction and appear...
Circulation, 2007
Background— The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking. Methods and Results— We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure ( P <0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P =0.031), the number ...