Rajiv Choudhary

Biomarkers in acute heart failure—state of the art

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.

The Use of Biomarkers in the Patient with Heart Failure

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.

Cardiac biomarkers: new tools for heart failure management

The last decade has seen exciting advances in the field of biomarkers used in managing patients with heart failure (HF). Biomarker research has broadened our knowledge base, shedding more light on the underlying pathophysiological mechanisms occurring in patients with both acute and chronic HF. The criterion required by an ideal cardiovascular biomarker has been progressively changing to an era of sensitive assays that can be used to guide treatment. Recent technological advances have made it possible to rapidly measure even minute amounts of these proteins by means of higher sensitivity assays. With a high prevalence of comorbidities associated with HF, an integrated approach utilizing multiple biomarkers have shown promise in predicting mortality, better risk stratification and reducing re-hospitalizations, thus lowering health-care costs. This review provides a brief insight into recent advances in the field of biomarkers currently used in the diagnosis and prognosis of patients with acute and chronic HF.

Cardiorenal biomarkers in acute heart failure

Managing patients with heart failure (HF) is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patients bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.

Neutrophil gelatinase-associated lipocalin as diagnostic and prognostic tool for cardiovascular disease and heart failure

INTRODUCTION Cardiovascular disease (CVD) has been a burden on the healthcare system for decades and has increased the need for earlier diagnosis, better risk stratification and cost- effective treatment to reduce the rates of hospitalization. Biomarker research has broadened our knowledge base, shedding more light on the underlying pathophysiological mechanisms associated with the development of heart disorders. Recent technological advances have made it possible to use noninvasive and cost-effective biomarkers for identifying patients who are at risk of developing coronary heart disease and atherosclerosis. AREAS COVERED In this paper the authors review the development of neutrophil gelatinase-associated lipocalin (NGAL) as a cardiac biomarker, highlighting studies that validate its use in predicting acute changes in patients with an array of cardiac disorders, and stake a case for the use of NGAL as a clinical diagnostic tool to predict outcomes in patients with CVD. EXPERT OPINION 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 NGALs stability in serum and urine, and to substantiate its widespread use, but there are expanding possibilities for this biomarker in clinical practice.

The appropriate use of biomarkers in heart failure.

Natriuretic peptides and troponins have been extensively studied and used in heart failure, and their value has been extensively discussed. Renal markers, such as cystasin-C, NGAL, and KIM-1, have shown growing utility in heart failure. The activation of compensatory pathways and ongoing hemodynamic changes result in the release of biomarkers that can be monitored to chart disease progression and possibly target for therapy.

Biomarkers for Diagnosis and Prognosis of Acute Heart Failure

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.