 |
|
Improved predictive value of biomarkers in HF makes earlier diagnosis and better management possible
March 30, 2009With an ever ageing population and more people surviving a heart attack, heart failure is now the world's most prevalent chronic cardiovascular disease. Yet despite improvements in its diagnosis and management, heart failure remains a stubbornly incurable condition with a poor prognosis, largely amenable to little more than palliative therapy.
Heart failure describes a syndrome of symptoms without a single diagnostic test. However, the discovery and application of markers of disease (biomarkers) have improved risk stratification in heart failure and made earlier detection possible. Now, reports in the April issue of the European Journal of Heart Failure suggest two more efficient applications of biomarkers, and with them the promise of even earlier diagnosis and improved treatment.
1. According to results from a study in Hull, UK, repeat measurement of the well established biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) once treatment has been optimised provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment. (1)
The finding emerged from a study of 354 patients with chronic heart failure treated in a community-based heart failure programme. Measurement of (NT-proBNP) was performed at baseline and, in those surviving (318), once again between the fourth and sixth month of follow-up. During the study follow-up period (a median of 39 months) 125 patients died, and analysis showed that follow-up NT-proBNP measurement proved a better predictor of death than either baseline NT-proBNP or change in NT-proBNP. Indeed, say the authors, NT-proBNP "was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalisations after baseline or follow-up assessment".
First author Dr Milos Kubanek from Castle Hill Hospital, Hull, UK, added: "NT-proBNP monitoring will enable the identification of patients who are not responding well to treatment or help flag those patients needing more aggressive management and monitoring. We found NT-proBNP to be a much stronger predictor of mortality and CV-hospitalisation than echocardiographic measurements of, for example, ejection fraction, and therefore repeat NT-proBNP measurement may enable a reduction in the number of repeat echocardiograms.
"We suggest that the main role of conventional echocardiography should be to diagnose and differentiate the principal causes of heart failure, with subsequent NT-proBNP monitoring used to identify worsening disease and trigger further echocardiographic assessment. Given the relatively high cost of echocardiography compared to NT-proBNP, such a policy is likely to be cost effective."
2. A study from Sweden suggests the combined application of two independently established biomarkers gives better prognostic information about the risk of cardiovascular mortality in heart failure patients than just one biomarker.(2) This was a study of 464 elderly patients with the symptoms of heart failure followed up over a ten-year period Linkoping University Hospital. Throughout that time serum measurements of the biomarker cystatin C (a marker of renal function) were taken, with results showing that those with levels within the highest quartile had almost three times the risk of cardiovascular death than those with levels in the first, second, or third quartiles.
However, when these measurements were combined with measurements of NT-proBNP, the mortality risk assessment was even more emphatic. For example, if those with high concentrations of cystatin C also had a plasma concentration of NT-proBNP within the highest quartile, the risk of death increased to more than 13 times over ten years of follow-up and almost 17 times after five years of follow-up.
The study's first author, Dr Urban Alehagen from the Heart Center of Linkoping University Hospital, Linkoping, Sweden, said: "Because the majority of patients with heart failure are elderly and often affected by other organ symptoms, including renal impairment, it is important to identify those at high risk, both for the provision of optimal treatment and the most effective use of health resources. The use of a single blood test and the analysis of two biomarkers is one way of identifying those patients where health resources are best focused. More and more clinicians are using information from natriuretic peptides. However, it is now possible to expand the use of these biomarkers in clinical practice, and our study proposes one such potent combination."
The use of biomarkers for identifying those at risk of cardiovascular mortality is now central to the management of patients with heart failure. Research now aims to find new, more sensitive markers and more efficient use of existing markers. The ultimate aim, as this issue of the European Journal of Heart Failure suggests, is to make earlier and more accurate diagnosis possible, and thereby improve treatment and survival.
Commenting on the implications of the findings, Professor Karl Swedberg, Editor-in-Chief of the European Journal of Heart Failure, said: "A combination of biomarkers to improve diagnosis and prognosis - as suggested by Alehagen and colleagues - now seems to be the basis of optimal management of patients with heart failure."
European Society of Cardiology
The finding emerged from a study of 354 patients with chronic heart failure treated in a community-based heart failure programme. Measurement of (NT-proBNP) was performed at baseline and, in those surviving (318), once again between the fourth and sixth month of follow-up. During the study follow-up period (a median of 39 months) 125 patients died, and analysis showed that follow-up NT-proBNP measurement proved a better predictor of death than either baseline NT-proBNP or change in NT-proBNP. Indeed, say the authors, NT-proBNP "was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalisations after baseline or follow-up assessment".
First author Dr Milos Kubanek from Castle Hill Hospital, Hull, UK, added: "NT-proBNP monitoring will enable the identification of patients who are not responding well to treatment or help flag those patients needing more aggressive management and monitoring. We found NT-proBNP to be a much stronger predictor of mortality and CV-hospitalisation than echocardiographic measurements of, for example, ejection fraction, and therefore repeat NT-proBNP measurement may enable a reduction in the number of repeat echocardiograms.
"We suggest that the main role of conventional echocardiography should be to diagnose and differentiate the principal causes of heart failure, with subsequent NT-proBNP monitoring used to identify worsening disease and trigger further echocardiographic assessment. Given the relatively high cost of echocardiography compared to NT-proBNP, such a policy is likely to be cost effective."
2. A study from Sweden suggests the combined application of two independently established biomarkers gives better prognostic information about the risk of cardiovascular mortality in heart failure patients than just one biomarker.(2) This was a study of 464 elderly patients with the symptoms of heart failure followed up over a ten-year period Linkoping University Hospital. Throughout that time serum measurements of the biomarker cystatin C (a marker of renal function) were taken, with results showing that those with levels within the highest quartile had almost three times the risk of cardiovascular death than those with levels in the first, second, or third quartiles.
However, when these measurements were combined with measurements of NT-proBNP, the mortality risk assessment was even more emphatic. For example, if those with high concentrations of cystatin C also had a plasma concentration of NT-proBNP within the highest quartile, the risk of death increased to more than 13 times over ten years of follow-up and almost 17 times after five years of follow-up.
The study's first author, Dr Urban Alehagen from the Heart Center of Linkoping University Hospital, Linkoping, Sweden, said: "Because the majority of patients with heart failure are elderly and often affected by other organ symptoms, including renal impairment, it is important to identify those at high risk, both for the provision of optimal treatment and the most effective use of health resources. The use of a single blood test and the analysis of two biomarkers is one way of identifying those patients where health resources are best focused. More and more clinicians are using information from natriuretic peptides. However, it is now possible to expand the use of these biomarkers in clinical practice, and our study proposes one such potent combination."
The use of biomarkers for identifying those at risk of cardiovascular mortality is now central to the management of patients with heart failure. Research now aims to find new, more sensitive markers and more efficient use of existing markers. The ultimate aim, as this issue of the European Journal of Heart Failure suggests, is to make earlier and more accurate diagnosis possible, and thereby improve treatment and survival.
Commenting on the implications of the findings, Professor Karl Swedberg, Editor-in-Chief of the European Journal of Heart Failure, said: "A combination of biomarkers to improve diagnosis and prognosis - as suggested by Alehagen and colleagues - now seems to be the basis of optimal management of patients with heart failure."
European Society of Cardiology
Heart Failure Current Events and Heart Failure News RSSInhibition of GRK2 is protective against acute cardiac stress injuries
Inhibition of a protein known to contribute to heart failure also appears to be protective of the heart in more acute cardiac stress injury, namely ischemia reperfusion.
Young athletes need dual screening tests for heart defects, study suggests
To best detect early signs of life-threatening heart defects in young athletes, screening programs should include both popular diagnostic tests, not just one of them, according to new research from heart experts at Johns Hopkins.
Protein changes in heart strengthen link between Alzheimer's disease and chronic heart failure
A team of U.S., Canadian and Italian scientists led by researchers at Johns Hopkins report evidence from studies in animals and humans supporting a link between Alzheimer's disease and chronic heart failure, two of the 10 leading causes of death in the United States.
Elevated biomarkers lead to diminished quality of life in heart attack patients post-discharge
Many heart attack patients have high levels of cardiac biomarkers in the blood for several months after leaving the hospital, with more shortness of breath and chest pain, according to a Henry Ford Hospital study.
Tiny particles can deliver antioxidant enzyme to injured heart cells
Researchers at Emory University and the Georgia Institute of Technology have developed microscopic polymer beads that can deliver an antioxidant enzyme made naturally by the body into the heart.
New study links vitamin D deficiency to cardiovascular disease and death
While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.
When seconds count: Interventional radiology treatment for pulmonary embolism saves lives
Catheter-directed therapy or catheter-directed thrombolysis-an interventional radiology treatment that uses targeted image-guided drug delivery with specially designed catheters to dissolve dangerous blood clots in the lungs-saves lives and should be considered a first-line treatment option for massive pulmonary embolism, note researchers in the November Journal of Vascular and Interventional Radiology.
Texas Children's discharges first pediatric patient with implanted mechanical heart device
Texas Children's Hospital is the nation's first pediatric hospital to discharge a child while on an intracorporeal ventricular assist device (VAD), a feat previously accomplished only at adult institutions.
Researchers develop innovative imaging system to study sudden cardiac arrest
A research team at Vanderbilt University has developed an innovative optical system to simultaneously image electrical activity and metabolic properties in the same region of a heart, to study the complex mechanisms that lead to sudden cardiac arrest.
Experts unveil new CVD guidelines and position papers
Several new guidelines and position papers offering the most up to date information to ensure that clinicians practice evidence-based medicine were released at the Canadian Cardiovascular Congress 2009 this week.
More Heart Failure Current Events and Heart Failure News Articles
 |
Success with Heart Failure (mass mkt ed): Help and Hope for Those with Congestive Heart Failure by Marc Silver (Author) Up-to-date information on available and forthcoming medical and surgical treatments. How attitude and emotion affect heart failure--and what you can do to stay positive. Tips for adopting a heart-healthy diet and lifestyle. Ways to forge a positive working relationship with your doctor or cardiologist. |
 |
The Cleveland Clinic Guide to Heart Failure (Cleveland Clinic Guides) by Randall Starling (Author) Expert medical advice from the #1 heart center in America for 14 years in a row
For the 5 million people with heart failure, there’s new reason for hope: recent medical advances have revolutionized how this condition is managed.
In The Cleveland Clinic Guide to Heart Failure, Dr. Randall Starling, one of the foremost authorities on heart health, provides authoritative advice to help people survive heart failure and enjoy a good quality of life. This comprehensive resource gives readers the cutting-edge medical guidance Dr. Starling offers his patients, including:
* Insight into what causes heart failure * The latest breakthrough studies – and what those discoveries mean for the future of this disease * Reliable guidance on diagnostic tests and treatment... |
 |
Heart Failure: Pathophysiology, Molecular Biology, and Clinical Management (HEART FAILURE: PATHOPHYSIOLOGY, MOLEC BIOL & CLIN MGT) by Arnold M Katz (Author), Marvin A Konstam (Author) This Second Edition of Dr. Katz's highly acclaimed text has been thoroughly revised to incorporate the latest advances in the study and treatment of heart failure. The book explains the pathophysiology, molecular mechanisms, clinical manifestations, and therapy of heart failure in an integrated, reader-friendly manner that is accessible to both clinicians and basic scientists. More than 100 illustrations, most created for this book by the authors, complement the text. This edition has been completely reorganized. Chapters describe the hemodynamic basis for the clinical manifestations of heart failure; the neurohumoral responses in heart failure and key signaling pathways that mediate functional responses; the proliferative responses in failing hearts; the cellular and molecular... |
 |
Manual of Heart Failure Management by John. D Bisognano (Editor), Marc. L. Baker (Editor), Mary Beth Earley (Editor) Heart failure is an increasingly common occurance in the patient population despite better treatment and management options available to clinicians. The focus is now increasingly turning towards prevention to reduce the rising incidence in addition to more efficacious treatment regimens. With emphasis on practical knowledge and easy reference, this title is designed to present the relevant diagnostic, management and treatment information in an easily digested and evidence-based algorithm format. With use of illustrations, readers will be able to rely on this text as a basic primer when studying patients with this complex and multifaceted set of diseases. |
 |
Heart Failure: A Practical Approach to Treatment by William Abraham (Author), Henry Krum (Author) The definitive one-stop guide to treating -- and preventing -- heart failure This practical reference provides all the expert guidance and up-to-the-minute clinical perspectives you need to diagnose, treat, and manage patients with heart failure. A major focus of the book is integration of various management approaches to maximize patient benefit. Coverage begins with a brief introduction to the incidence and causes of heart failure, then quickly moves into a more thorough clinical overview of symptom evaluation, pharmacologic and non-pharmacologic treatment methods, hospitalization, surgical treatments, and more. Features: Clear, step-by-step coverage of prevention and all treatment modalities with evidence-based recommendations Full... |
 |
ABC of Heart Failure (ABC Series) by Russell C. Davis (Author), Michael K. Davies (Author), Gregory Y. H. Lip (Author) This new edition of the ABC of Heart Failure provides coherent and concise information relating to the epidemiology, pathophysiology and clinical features, aiding the diagnosis and treatment of this life threatening condition. Fully updated to cover all the latest advances, the ABC of Heart Failure is an invaluable reference for general practitioners, hospital doctors, nurses and other healthcare professionals involved in the treatment and prevention of heart failure. |
 |
Heart Failure Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body?s other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart?s pumping action is a symptom of an underlying heart problem. Heart failure affects nearly 5 million US adults. It is on the rise with an estimated 400,000 to 700,000 new cases each year. This talk will focus on the causes, symptoms, diagnosis and treatments available for heart failure, including current research findings from Stanford. |
 |
FlameEz-Heart, 60 Capsules/Bottle by FlameEz Conditions that damage the heart muscle or make it work too hard can cause heart failure. Over time, the heart weakens and certain inflammatory substances may be released into the blood, which have a toxic effect on the heart and cause heart failure to worsen. The most common causes of heart failure are coronary artery disease, high blood pressure, and diabetes, all of which are associated with chronic inflammation. Inflammatory cytokines suppress heart contractility, initiate hypertrophy and promote cell death or fibrosis. Results from a recent study land additional support that obesity causes prolonged inflammation of heart tissue that in turn boosts heart failure risk. New studies also suggest that modulation of inflammatory and immune responses may offer some hope to improve heart... |
|
Holy Heart Failure by Holy Heart Failure | |
|
Pathophysiology For Nurses: Heart Failure and Pulmonary Edema (VHS) Also With: Mosby (Producer) |
| © 2009 BrightSurf.com |