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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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Concurrent imaging of metabolic and electric signals in the heart
Cardiac rhythm disorders can result from disturbances in cardiac metabolism. These metabolic changes are tightly linked with specific cardiac electrophysiology (CEP) abnormalities, such as depressed excitability, impaired intra- and extracellular conductivities, wave propagation block, and alteration of conduction velocity, action potential amplitude, and duration.
Canadian cardiology team clears the way for lifesaving breast cancer treatment
A team of Canadian cardiologists, in collaboration with oncologists, are playing an important role in the war against breast cancer Dr. Michael McDonald told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
'Superobesity,' chronic disease burden associated with risk of death following bariatric surgery
Veterans classified as superobese and those with a higher chronic disease burden appear more likely to die within a year of having bariatric surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Thyroid surgery safe for older patients, study finds
Thyroid surgery is safe for older patients, say physicians who found only slight differences in rates of complications and hospital readmissions in a multi-year study.
New mathematical model more accurately diagnoses acute heart failure in emergency rooms
Researchers at St. Michael's Hospital have developed the first mathematical model in cardiology and emergency medicine to more quickly and reliably diagnose acute heart failure (AHF) in emergency room patients.
Cost Effectiveness of Blood Pressure Device Evaluated
A study conducted by the University of Rochester Medical Center (URMC) demonstrates that, for certain patient populations, an experimental device that lowers blood pressure may be a cost effective treatment. The implantable device, called Rheos, is in advanced stages of testing for individuals with drug resistant hypertension.
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