title: Biomarkers: optimizing treatment guidance in heart failure.
abstract: Heart failure is a frequent and life-threatening syndrome which is not only the result of myocardial injury or hemodynamic overload as commonly perceived, but appears to be the result of an interplay among genetic, neurohormonal, inflammatory, and biochemical factors, collectively referred to as biomarkers. Biomarkers can become risk factors in case their therapeutic modification results in an improvement of clinical outcomes. Among those markers identified in patients with heart failure, a number appears to have direct clinical relevance in aiding diagnosis, risk stratification, monitoring therapy, and treating to targets in order to improve clinical outcomes. These include brain natriuretic peptides (e.g., BNP, NT-proBNP), inflammatory markers (e.g., hsCRP), neurohormones (e.g., aldosterone), cardiorenal markers (e.g., cycstatin C), and novel markers (e.g., galectin-3). While their utility to indicate risk is mostly well established, there are less data to establish that a treatment using biomarkers as a guidance results in better outcomes than a more generalized intensified treatment of patients with heart failure. Future directions may involve larger platforms that facilitate to simultaneously analyze hundreds of biomarkers and may help to tailor heart failure therapy on a single patient basis, considering the specific pathogenesis and prognosis. Also from a therapeutic perspective there are data that a single intervention such as aldosterone blockade may affect multiple biomarkers at the same time. Taken together the data indicate that biomarkers are evolving into a valuable addendum to the diagnostic and therapeutic armamentarium.
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. michael.boehm@uniklinikum-saarland.de
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ketelslegers
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Schirmer
authors.forename: Eva
authors.initials: E
authors.lastname: Turgonyi
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D000450:Aldosterone / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D005109:Extracellular Matrix / Q000378:metabolism; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D045265:Natriuretic Peptides / Q000097:blood; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D000450:Aldosterone