title: [Diagnosis of acute heart failure and relevance of biomarkers in elderly patients].
abstract: Diagnosis of acute heart failure (HF) is difficult in elderly patients with multiple comorbidities. Risk scales and classification criteria based exclusively on clinical manifestations, such as the Framingham scales, lack sufficient specificity. In addition to clinical manifestations, diagnosis should be based on two key factors: natriuretic peptides and echocardiographic study. When there is clinical suspicion of acute HF, a normal natriuretic peptide level will rule out this process. When a consistent clinical suspicion is present, an echocardiographic study should also be performed. Diagnosis of HF with preserved ejection fraction (HF/pEF) requires detection of an enlarged left atrium or the presence of parameters of diastolic dysfunction. Elevation of cardiac biomarkers seems to be due to myocardial injury and the compensatory mechanisms of the body against this injury (hormone and inflammatory response and repair mechanisms). Elevation of markers of cardiac damage (troponins and natriuretic peptides) have been shown to be useful both in the diagnosis of acute HF and in prediction of outcome. MMP-2 could be useful in the diagnosis of HF/pEF. In addition to biomarkers with diagnostic value, other biomarkers are helpful in prognosis in the acute phase of HF, such as biomarkers of renal failure (eGFR, cystatin and urea), inflammation (cytokines and CRP), and the cell regeneration marker, galectin-3. A promising idea that is under investigation is the use of panels of biomarkers, which could allow more accurate diagnosis and prognosis of acute HF.
authors.affiliation: Departamento de Medicina Interna, IMIBIC/Hospital Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, España.
authors.forename: Raúl Antonio
authors.initials: RA
authors.lastname: Ruiz Ortega
authors.affiliation: Unidad de Insuficiencia Cardíaca y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.affiliation: Departamento de Medicina Interna, IMIBIC/Hospital Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, España. Electronic address: montero.manolo@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Pérez-Barquero
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood*; D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D004417:Dyspnea / Q000209:etiology; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood; D011379:Prognosis; D011654:Pulmonary Edema / Q000209:etiology; D013318:Stroke Volume; D014336:Troponin / Q000097:blood; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D016207:Cytokines; D045265:Natriuretic Peptides; D014336:Troponin; D020778:Matrix Metalloproteinase 2
keywords: Acute heart failure; Biomarcadores; Biomarkers; Diagnosis; Diagnóstico; Insuficiencia cardíaca aguda; Prognosis; Pronóstico