Table 10: Selected biomarkers with potential for future clinical use in the management of HF
| Biomarkers: 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 etiology |
| 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 |
| Biomarkers: sST2 |
| 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 week-to-week variations |
| Potential Benefits |
| Could provide additional value for short and long term prognostication, regardless of LVEF |
| Challenges before implementation |
| Unclear if using sST2 in acute or chronic HF to modify therapies improves clinical outcomes |
| Biomarkers: Procalcitonin |
| Pathophysiological pathways/comorbid conditions with prognostic implications |
| Bacterial infection |
| HF populations targeted |
| Acute HF |
| Advantages |
| Early detection of bacterial infection |
| Potential Benefits |
| Guiding antibiotic therapy in acute HF and suspected respiratory infection |
| Challenges before implementation |
| Levels are increased in HF without ongoing bacterial infection. No clear cutoff has been identified in the HF population. |
| Biomarkers: 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 |
| ST2 may be superior to galectin-3 in a multivariable risk prediction model |
| Biomarkers: 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 |
| Preventive measures and therapy optimization based on levels could improve outcomes |
| Challenges before implementation |
| Unclear if using cystatin C, over using eGFR, to modify clinical management provides further clinical benefit |
| Biomarkers: 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 |
*This list is not exhaustive; multiple biomarkers have been and are being studied.
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;
NPs, natriuretic peptides;
sST2, soluble toll-like receptor-2.