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Novel biomarkers in heart failure
June 01, 2009Several new biomarkers have been recently described in Heart Failure (HF) syndrome either in stable chronic patients as in the settings of acute decompensation. Biomarkers are used to diagnose disease risk, to predict outcome and to tailor treatment to individuals.
Speaking at a press conference at Heart Failure 2009 in Nice, France, Prof Piotr Ponikowski, spokesperson for the European Society of Cardiology, presented these new findings, namely:
* ST2 - a member of the interleukin (IL)-1 receptor family, markedly upregulated on the application of mechanical strain to cardiac myocytes; reported to be elevated in severe chronic HF, where independently predicts poor outcome; serial monitoring in acute decompensated HF may be useful for risk stratification
* ultrasensitive troponins reflecting damage/loss of cardiomyocytes; elevation in chronic HF identifies poor outcome
* advanced glycation end-products (AGEs) - molecules formed during a non-enzymatic reaction between proteins and sugar residues; there is an evidence that AGEs are related to the development and progression of HF in diabetic and non-diabetic patients;
* adrenomedullin - hormone which is a potent vasodilator, with inotropic and natriuretic properties; assessment of mid-regional part of the proadrenomedullin (MR-proADM test) has been proved to add additional information on standard of care in the diagnosis of acute HF and to be useful in prognostic evaluation of these patients
* estrogens - it has been recently shown that both low and high concentrations of circulating estradiol are powerful predictors of a poor prognosis in men with chronic HF; subjects with either reduced or increased concentrations of serum E2 have different clinical characteristics, suggesting that the underlying pathophysiological mechanisms are not the same
"Biomarker" is a very broad term that refers to parameter reflecting or characterizing a certain biological process. It may include variety of indices/parameters derived from clinical images, physiological tests, tissue biopsies, and even genetic variants, but most often, this term is reserved for blood or urine based assessments.
As examples of biomarkers assessed in the blood, which are already well established and widely used in clinical practice:
* for lipid metabolism - blood cholesterol or LDL-cholesterol levels
* for glucose metabolism - glycated hemoglobin (HbA1c)
* for kidney function - creatinine, or recently cystatin C
* for inflammation - C-reactive protein (CRP)
* for anemia - hemoglobin
* for cardiac function -natriuretic peptides
Biomarker assessments are used in many clinical scenarios, in the emergency department, on the ward, in the outpatient clinic and in the near future at the patient's home (using telemedicine platform).
In heart failure, biomarkers aid in the diagnosis, help to assess co-morbidities in patients, may be useful in the risk stratification, monitoring of therapy and even serve as a therapeutic target. Importantly, many biomarkers may provide an insight into the pathophysiology of HF.
"The field of HF biomarkers continues to grow exponentially", explains Prof Ponikowski from Military Hospital in Wroclaw, Poland. "The following is a new classification, recently proposed by Prof Eugene Braunwald, according to which biomarkers can reflect/characterize different aspects of HF:
* inflammation
* oxidative stress
* extracellular-matrix remodeling
* neurohormones
* myocyte injury
* myocyte stress"
European Society of Cardiology
* ultrasensitive troponins reflecting damage/loss of cardiomyocytes; elevation in chronic HF identifies poor outcome
* advanced glycation end-products (AGEs) - molecules formed during a non-enzymatic reaction between proteins and sugar residues; there is an evidence that AGEs are related to the development and progression of HF in diabetic and non-diabetic patients;
* adrenomedullin - hormone which is a potent vasodilator, with inotropic and natriuretic properties; assessment of mid-regional part of the proadrenomedullin (MR-proADM test) has been proved to add additional information on standard of care in the diagnosis of acute HF and to be useful in prognostic evaluation of these patients
* estrogens - it has been recently shown that both low and high concentrations of circulating estradiol are powerful predictors of a poor prognosis in men with chronic HF; subjects with either reduced or increased concentrations of serum E2 have different clinical characteristics, suggesting that the underlying pathophysiological mechanisms are not the same
"Biomarker" is a very broad term that refers to parameter reflecting or characterizing a certain biological process. It may include variety of indices/parameters derived from clinical images, physiological tests, tissue biopsies, and even genetic variants, but most often, this term is reserved for blood or urine based assessments.
As examples of biomarkers assessed in the blood, which are already well established and widely used in clinical practice:
* for lipid metabolism - blood cholesterol or LDL-cholesterol levels
* for glucose metabolism - glycated hemoglobin (HbA1c)
* for kidney function - creatinine, or recently cystatin C
* for inflammation - C-reactive protein (CRP)
* for anemia - hemoglobin
* for cardiac function -natriuretic peptides
Biomarker assessments are used in many clinical scenarios, in the emergency department, on the ward, in the outpatient clinic and in the near future at the patient's home (using telemedicine platform).
In heart failure, biomarkers aid in the diagnosis, help to assess co-morbidities in patients, may be useful in the risk stratification, monitoring of therapy and even serve as a therapeutic target. Importantly, many biomarkers may provide an insight into the pathophysiology of HF.
"The field of HF biomarkers continues to grow exponentially", explains Prof Ponikowski from Military Hospital in Wroclaw, Poland. "The following is a new classification, recently proposed by Prof Eugene Braunwald, according to which biomarkers can reflect/characterize different aspects of HF:
* inflammation
* oxidative stress
* extracellular-matrix remodeling
* neurohormones
* myocyte injury
* myocyte stress"
European Society of Cardiology
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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.
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