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Early detection of myocardial dysfunction and heart failure

Nature Reviews Cardiology volume 7, pages 334–344 (2010)Cite this article

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Abstract

The impact of cardiac dysfunction and heart failure is continuing to escalate in the developed world. Treatment of this heterogeneous condition has focused on the symptomatic stage, often after irreversible remodeling and functional impairment have occurred. Early identification of cardiac dysfunction would allow implementation of early intervention strategies to delay the progression or to prevent the onset of heart failure altogether. Although screening methods for asymptomatic cardiac dysfunction have yet to be optimized, a staged approach for patients with predisposing risk factors using serological biomarkers followed by noninvasive imaging techniques may be useful. Existing biomarkers for cardiac dysfunction include B-type natriuretic peptide, troponins, and C-reactive protein. Novel markers such as protein ST2, galectin-3, and various prohormones are emerging and may provide prognostic information that is incremental to conventional clinical evaluation. Monitoring myocardial mechanics and molecular processes through three-dimensional speckle tracking and hybrid imaging modalities, such as PET–CT, may provide insight into disease manifestation before overt structural and physiological abnormalities.

Key Points

  • The increase in the prevalence of heart failure and its late symptomatic presentation require novel approaches to assist in the early detection of myocardial dysfunction

  • Novel serological biomarkers are emerging as independent predictors of adverse outcomes and contribute incremental prognostic information to traditional risk factors and B-type natriuretic peptide levels in heart failure

  • Imaging tools that assess myocardial mechanics and molecular processes provide improved sensitivity and specificity for disease identification and progression

  • A tandem approach using multiple representative biomarkers with molecular or multimodal imaging tools may provide additional risk stratification and evaluation of disease

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Figure 1: BNP in the clinical setting.
Figure 2: Biomarker discovery.
Figure 3: Multimarker strategy to improve diagnostic performance as illustrated by receiver operating characteristic curves.
Figure 4: Three-dimensional echocardiography Doppler speckle tracking demonstrating cardiac dysfunction secondary to myocardial infarction.
Figure 5: Use of PET and CT multimodal hybrid imaging to detect cardiac dysfunction.

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  1. Toronto General Hospital, University Health Network, NCSB 11-1266, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada

    Geoffrey de Couto, Maral Ouzounian & Peter P. Liu

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P. P. Liu declares that he has received grant/research support from Roche Diagnostics GmbH. The other authors declare no competing interests.

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de Couto, G., Ouzounian, M. & Liu, P. Early detection of myocardial dysfunction and heart failure. Nat Rev Cardiol 7, 334–344 (2010). https://doi.org/10.1038/nrcardio.2010.51

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