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  • Review Article
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Novel biomarkers in chronic heart failure

Nature Reviews Cardiology volume 9, pages 347–359 (2012)Cite this article

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Abstract

Understanding of chronic heart failure (HF) has progressed from a syndrome of disordered hemodynamics caused by alterations in the structure of the heart to one that involves intertwined molecular pathways in disarray. Accordingly, the assessment and treatment of patients with chronic HF has shifted from a focus on hemodynamics to modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers of disease could provide a unique window into the pathophysiology of chronic HF, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. The more 'traditional' biomarkers such as cardiac troponin, natriuretic peptides, and C-reactive protein have been studied in large cohorts of patients with chronic HF and have relatively established clinical applications. In this Review, we summarize the properties, clinical data, and potential applications of some emerging biomarkers that could uniquely indicate the level of biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occurs in chronic HF. We will also discuss the potential role for these biomarkers within a multimarker-based strategy that could, in the future, lead to better care for these patients.

Key Points

  • Chronic heart failure is a major health problem that results from maladaptive signaling within intertwined molecular pathways

  • Several novel biomarkers have been identified that allow measurement of the multitude of molecular processes involved in the pathophysiology of chronic heart failure

  • The clinical use of biomarkers could result in improved diagnosis, risk assessment, and treatment of patients with chronic heart failure

  • Considerable interest exists in the use of a multimarker strategy for parallel evaluation of traditional and novel biomarkers in patients with chronic heart failure

  • The goal of a multimarker strategy would be to classify chronic heart failure on a molecular basis and tailor therapies accordingly

  • New therapies for chronic heart failure could emerge from the measurement of novel biomarkers in patients with this condition

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Figure 1: HF as a systemic illness.
Figure 2: Possible future strategies for biomarker-guided therapies in chronic HF.

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Acknowledgements

The authors would like to thank Linda K. Shaw (Senior Statistician, Duke Clinical Research Institute, Durham, NC, USA) for her valuable feedback on the discussion about statistical methods.

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Authors and Affiliations

  1. Division of Cardiology, Duke University School of Medicine, 2400 Pratt Street, Durham, 27705, NC, USA

    Tariq Ahmad, G. Michael Felker & Christopher O'Connor

  2. Division of Clinical Pharmacology, Duke University School of Medicine, 2400 Pratt Street, Durham, 27705, NC, USA

    Mona Fiuzat

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  1. Tariq Ahmad
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Contributions

T. Ahmad researched the data for the article. All the authors contributed equally to discussions of the content and to writing the article. M. Fiuzat, G. M. Felker and C. O'Connor reviewed and/or edited the manuscript before submission.

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Correspondence to Tariq Ahmad.

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Competing interests

M. Fiuzat, G. M. Felker and C. O'Connor have received research support from BG Medicine, Critical Diagnostics, and Roche. G. M. Felker and C. O'Connor have acted as consultants for Roche. T. Ahmad declares no competing interests.

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Ahmad, T., Fiuzat, M., Felker, G. et al. Novel biomarkers in chronic heart failure. Nat Rev Cardiol 9, 347–359 (2012). https://doi.org/10.1038/nrcardio.2012.37

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