| NGAL |
|---|
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Renal function |
| HF populations targeted |
| Acute HF |
| Advantages |
| Early detection of renal function deterioration |
| Potential benefits |
| Adjusting therapy to improve prognosis by avoiding acute renal failure progression |
| Challenges before implementation |
| Unclear if using NGAL in acute HF to modify therapies improves clinical outcomes |
| Cystatin C |
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Renal function |
| HF populations targeted |
| Acute and chronic HF |
| Advantages |
| More sensitive detection of changes in renal function |
| Potential benefits |
| Adjusting therapy to improve prognosis by avoiding acute renal failure progression |
| Challenges before implementation |
| Unclear if using cystatin C, over using eGFR, to modify clinical management provides further clinical benefit |
| Cardiac hs-troponins |
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Myocyte death |
| HF populations targeted |
| Acute and chronic HF |
| Advantages |
| Very sensitive marker predicting higher risk of CV events regardless of aetiology |
| Potential benefits |
| Optimization of therapy in patients with elevated hs-cTn should be more aggressive |
| Challenges before implementation |
| Prognostication improves only for mortality and use to modify therapy has not been tested |
| ST2 |
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Fibrosis/inflammation/ immunity |
| HF populations targeted |
| Acute and chronic HFrEF, HFpEF, and previously low EF recovered |
| Advantages |
| Additional prognostic\ value beyond NPs\ suspected low weekto-\ week variations |
| Potential benefits |
| Could provide additional value for short and long term prognostication, regardless of LVEF |
| Challenges before implementation |
| Unclear if using ST2 in acute HF to modify therapies improves clinical outcomes |
| Galectin-3 |
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Cardiac and vascular fibrosis |
| HF populations targeted |
| Incident HF, HFrEF and HFpEF |
| Advantages |
| Early detection of risk and long term prognostication in HF |
| Potential benefits |
| Preventive measures and therapy optimization based on levels could improve outcomes |
| Challenges before implementation |
| Recent study showed ST2 superior to galectin-3 in a multivariable prediction model |
CV, cardiovascular; EF, ejection fraction; eGFR, estimated glomerular filtration rate; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; hs, high-sensitivity; hs-cTn, high sensitivity cardiac troponin; LVEF, left ventricular ejection fraction; NGAL, neutrophil gelatinase-associated lipocalin; ST2, soluble toll-like receptor-2.