Clinical Value of Blood Biomarkers in Patients With Chronic Heart Failure

Abstract

Biomarkers (various laboratory biochemical markers), such as natriuretic peptides (NP), soluble ST2 receptor, copeptin, galectin-3, are widely studied in patients with chronic heart failure (CHF). The European Society of Cardiology recommends the determination of blood NP level in suspicion of HF and its use as one of the mandatory diagnostic criteria for CHF with preserved and mid-range ejection fraction. Dynamics of NP concentration may be predictor of the effectiveness of the therapy and the necessity of the titration of the dose of HF drugs. Neprilyzin destroys NP, but does not destroy their precursors, including NT-proBNP. Therefore, it is necessary to use NT-proBNP as a marker of therapeutic efficacy and prognosis when using neprilysine inhibitors (sacubitril). ST2 is a protein receptor for interleukin-33 (IL-33). The transmembrane ST2 (ST2L) binds to IL-33 and forms the IL-33/ST2L complex, which has a cardioprotective effect, prevents the development of myocardial hypertrophy, fibrosis and apoptosis. The soluble ST2 receptor (sST2) is a “trap” for IL-33 and neutralizes the protective effects of the IL-33/ST2L complex, which leads to hypertrophy and fibrosis of the myocardium, dilatation of the chambers and reduction of the contractility of the heart. It can be considered as a marker of unfavorable prognosis in heart failure, but it is not specific. Copeptin is a part of the arginine-vasopressin, or antidiuretic hormone, precursor which plays an important role in the pathogenesis of CHF. Since arginine-vasopressin has a short half-life and is unstable outside the body, copeptin is being actively investigated. Its level increases during the CHF decompensation and relates with the functional class of CHF. A combined measurement of the concentration of copeptin and NP may improve the risk stratification in CHF patients. Galectin-3 is a peptide that stimulates the activation of fibroblasts and the development of fibrosis. It increases in CHF patients and is associated with the severity of the condition, systolic and diastolic LV dysfunction and prognosis. Currently, NP are the best biomarkers that can and should be used in routine clinical practice. To prove the need for widespread use of other biomarkers, additional research is needed.

The Value of Biomarkers in the Diagnosis and Prognosis of Heart Failure in Older Age

“…В связи с низкой специфичностью симптомов СН и несвоевременной диагностикой на ранних стадиях, вероятностью недостаточной или некорректной интерпретации эхокардиограмм, в качестве альтернативного диагностического подхода возможно определение в крови лабораторных биохимических маркеров [1,12].…”

“…НУП обладают сходной биохимической структурой, включающей кольцеобразное аминокислотное ядро, N-аминный и C-карбоксильный концевые фрагменты, что позволяет объединить их в одну группу [12,14] (табл. 1).…”

“…N-terminal pro-B-type natriuretic peptide, или NT-proBNP -N-концевой-проМНУП) биологически инертны и имеют диагностическое значение. С-концевые фрагменты обладают активностью и являются гормонами -ПНУП (ANP) и МНУП (BNP) [12,14].…”

“…Основные физиологические эффекты НУП представлены ниже [12,14,[19][20][21] НУП обладают как рядом преимуществ (простота и доступность исследования, высокая прогностическая значимость), так и недостатков (широкая вариабельность значений, обусловленная зависимостью от пола, возраста и сопутствующей патологии) (табл. 2).…”

“…• диагностика СН и подтверждение диагноза при одышке, утомляемости и отёках; • исключение альтернативных причин одышки; • оценка прогноза; • достижение рекомендованной медикаментозной терапии [12,13,23,24].…”