Predictive Value of Biomarkers in Patients with Heart Failure

Abstract

Heart failure (HF) is a complex syndrome with high morbidity and mortality while, myocardial injury, hemodynamic overload, genetic, neurohormonal, inflammatory and biochemical factors are implicated in the development and progression of the disease. Interestingly, despite the development of several diagnostic tests, HF diagnosis remains clinical, based on symptoms and signs, while there is a poor relationship between symptoms and the prognosis of HF. Several biomarkers have recently been examined for their efficacy to predict outcome and assess prognosis of HF patients. The best studied for its prognostic ability sub-group of biomarkers is the neurohormones including the natriuretic peptides, the components of the renin-angiotensin-aldosterone system and the catecholamines. Others sub-groups of biomarkers include inflammatory and oxidative stress markers, extracellular matrix remodeling markers and myocardial injury markers (such as troponins I and T). Nevertheless, it is difficult to access a single biomarker fulfilling our need to evaluate prognosis and guiding treatment in acute or chronic HF patients, thus the predictive ability of combined biomarkers is recently under research. Therefore, further studies are needed to elucidate the clinical significance of these biomarkers. In the present review, we will discuss the usefulness and significance of potentials or established biomarkers in HF patients focusing on their ability to predict adverse events, morbidity and mortality.

The diagnostic significance of cardiac biomarkers in veterinary medicine

“…Cardiac troponins (cTn) are the most common "leak- the deterioration of cardiac function and the overall prognosis (Fonfara et al, 2010;Tousoulis et al, 2012). Recently, persistently elevated cTnI levels in dogs with endocardiosis were associated with the slowly worsening clinical status, thus indicating the advancement of heart failure.…”

“…Recently, persistently elevated cTnI levels in dogs with endocardiosis were associated with the slowly worsening clinical status, thus indicating the advancement of heart failure. In the latter, increased cTnI concentration is probably attributed to the ongoing myocardial injury and cardiac remodelling lesions which follow chronic hemodynamic abnormalities inflicted by this condition (Tousoulis et al, 2012;Polizopoulou et al, 2014). Nevertheless, and because troponins have been shown to increase in many cardiac and some noncardiac diseases (e.g.…”

“…Acute phase proteins (APP) are released from hepatic cells after stimulation by pro-inflammatory cytokines, early in the inflammatory process. In particular, C-reactive protein (CRP), a major positive APP in the dog, has been used as a marker for cardiovascular diseases in humans and animals (Anand et al, 2005;Rush et al, 2006;Saunders, 2009;Tousoulis et al, 2012). It has been postulated that in chronic heart disease the damaged myocardium triggers the production of proinflammatory cytokines (TNF-α, interleukins 1, 6, 18), which induce apoptosis and necrosis of cardiac cells and lead to a vicious cycle with further myocardial dysfunction and finally failure.…”

“…It has been postulated that in chronic heart disease the damaged myocardium triggers the production of proinflammatory cytokines (TNF-α, interleukins 1, 6, 18), which induce apoptosis and necrosis of cardiac cells and lead to a vicious cycle with further myocardial dysfunction and finally failure. Progressive hemodynamic overload, imbalance between proand anti-inflammatory mediators contribute to the establishment of heart failure (Tousoulis et al 2012).…”

Inflammatory Modulation by Statins and Heart Failure

“…of HF patients [11,12]. Immune system activation plays a major role in many cardiac diseases leading to HF and in the progression of cardiac remodeling in HF [13,14].…”