Advancements in biomarkers for cardiovascular disease: diagnosis, prognosis, and therapy - PubMed (original) (raw)

Review

Advancements in biomarkers for cardiovascular disease: diagnosis, prognosis, and therapy

Nicholas Wettersten et al. Fac Rev. 2021.

Abstract

Biomarkers are essential tools in the practice of cardiology. They assist with diagnosis, prognosis, and guiding therapy in many different cardiovascular diseases. Numerous biomarkers have become strongly associated with different cardiovascular conditions, such as troponin with acute coronary syndrome and natriuretic peptides with heart failure. Even though these biomarkers have been in practice for almost two decades, their uses continue to expand beyond their original roles. Additionally, many new biomarkers have been discovered with increasing utility in cardiovascular disease, including soluble suppression of tumorigenicity 2, galectin 3, and biomarkers of fibrosis, metabolism, and inflammation. How these old and new biomarkers are being expanded into clinical practice is constantly in evolution. This review will highlight some of the recent major advancements in the rapidly evolving field of biomarkers.

Keywords: Biomarkers; acute coronary syndrome; heart failure; prevention.

Copyright: © 2021 Wettersten N et al.

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Conflict of interest statement

The authors declare that they have no competing interests.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.

Figure 1.. The rapid rule-out algorithm.

Assessment of high-sensitivity cardiac troponin (hs-cTn) in patients presenting with suspected myocardial infarction can lead to three different pathways with either 0/1-hour algorithm or 0/2-hour algorithm. If a patient presents more than 3 hours after chest pain and has a very low hs-cTn, they can be ruled out. If the patient presents within 3 hours or does not have a very low hs-cTn, a rapid reassessment at 1 or 2 hours with minimal change in hs-cTn rules out myocardial infarction. Very high initial values or changes in values rule in a patient for myocardial infarction. For patients not meeting either criterion, further observation with serial testing of hs-cTn should be performed. Cut-offs for change at 1 or 2 hours are assay-specific. Pathway adapted from the European Society of Cardiology Guidelines.

Figure 2.

Figure 2.. Suggested approach to natriuretic peptide–guided therapy.

Patients with chronic heart failure should have an NT-proBNP assessed early in the disease course. Medical therapy should be aggressively titrated to goal dosing or highest tolerated doses. Once the patient is optimized, NT-proBNP can be reassessed. If it is less than 1000 pg/mL, the patient is low risk for adverse heart failure outcomes. If it is greater than 1000 pg/mL, attempts should be made to further optimize therapy as much as possible. If it remains greater than 1000 pg/mL, referral for evaluation of advanced heart failure, further risk stratification, and possible advanced therapies should be considered. CRT, cardiac resynchronization therapy; NT-proBNP, N-terminal pro B-type natriuretic peptide.

Figure 3.

Figure 3.. Proposed integrated biomarker pathway for prevention, diagnosis, prognosis, and therapeutic monitoring of the cardiac patient.

Patients at risk for CVD should be risk stratified with BNP, hs-cTn, and Gal-3 for risk of developing CVD (that is, ACS, stroke, and heart failure). Low-risk patients should undergo intermittent reassessment of risk with biomarkers, similar to assessing hemoglobin A1c in patients at risk for diabetes mellitus. High-risk patients should be provided aggressive disease-modifying therapies. If an ACS event is suspected to occur, hs-cTn can be used to rule in or out a myocardial infarction. In those with myocardial infarction, assessment of natriuretic peptides, Gal-3, and potentially GDF-15 can identify high-risk individuals for more-aggressive therapy and surveillance. If a patient develops heart failure, patients should be risk-stratified with natriuretic peptides, hs-cTn, and sST2 before and after optimization of medical therapy. Those with biomarkers persistently above cut-offs should be considered high-risk and potentially referred to an advanced heart failure center for further evaluation and consideration for advanced therapies. BNP, B type natriuretic peptide; Gal-3, galectin 3; GDF-15, growth differentiation factor 15; hs-cTn, high-sensitivity cardiac troponin; NT-proBNP, N-terminal proBNP; sST2, soluble suppressor of tumorigenicity 2; TBD, to be determined.

References

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    2. Faculty Opinions Recommendation
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    2. Faculty Opinions Recommendation

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