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Review |
Departments of1 Pathology and Laboratory Medicine, 2 Medicine/Cardiology, 3 Physiology and Biophysics, and 4 Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, KY 40292.
aAddress correspondence to this author at: Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40292. Fax 502-852-7674; e-mail rvaldes{at}louisville.edu.
Background: Heart failure (HF) is a devastating disease with increasing prevalence in elderly populations. One-half of all patients die within 5 years of diagnosis. The annual cost of treating patients with HF in the US is more than $20 billion, which is estimated to be greater than that of myocardial infarction and all cancers combined. Given the complex pathophysiology and varied manifestations of HF, interest has intensified in developing biological markers to predict susceptibility and aid in the early diagnosis and management of this disease.
Methods: We searched Medline via Ovid for studies published during the period 1966–2003 regarding various biomarkers suggested for HF. Our review focused on developing strategies for discovering and using new biomarkers, particularly those potentially linked to pathophysiologic mechanisms. We also point out strategic advantages, limitations, and methods available for measuring each of the currently proposed markers.
Results: Biomarkers reviewed include those released from the heart during normal homeostasis (natriuretic peptides), those produced elsewhere that act on the heart (endogenous cardiotonic steroids and other hormones), and those released in response to tissue damage (inflammatory cytokines). The concept of using a combination of multiple markers based on diagnosis, prognosis, and acute vs chronic disease is also discussed. In view of recent advances in our understanding of molecular biochemical derangements observed during cardiac failure, we consider the concept of myocardial remodeling and the heart as part of an endocrine system as strategies.
Conclusion: Strategically, biomarkers linked to mechanisms involved in the etiology of HF, such as dysregulation of ion transport, seem best suited for serving as early biological markers to predict and diagnose disease, select therapy, or assess progression.
The following articles in journals at HighWire Press have cited this article:
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  K. H. Miettinen, J. Lassus, V.-P. Harjola, K. Siirila-Waris, J. Melin, K. R. Punnonen, M. S. Nieminen, M. Laakso, and K. J. Peuhkurinen Prognostic role of pro- and anti-inflammatory cytokines and their polymorphisms in acute decompensated heart failure Eur J Heart Fail, April 1, 2008; 10(4): 396 - 403. [Abstract] [Full Text] [PDF]
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 S. von Haehling, E. A. Jankowska, N. G. Morgenthaler, C. Vassanelli, L. Zanolla, P. Rozentryt, G. S. Filippatos, W. Doehner, F. Koehler, J. Papassotiriou, et al. Comparison of Midregional Pro-Atrial Natriuretic Peptide With N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Survival in Patients With Chronic Heart Failure J. Am. Coll. Cardiol., November 13, 2007; 50(20): 1973 - 1980. [Abstract] [Full Text] [PDF]
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 C. Vassalle, M. G. Andreassi, C. Prontera, M. Fontana, L. Zyw, C. Passino, and M. Emdin Influence of ScaI and Natriuretic Peptide (NP) Clearance Receptor Polymorphisms of the NP System on NP Concentration in Chronic Heart Failure Clin. Chem., November 1, 2007; 53(11): 1886 - 1890. [Abstract] [Full Text] [PDF]
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 J. P. Goetze, R. Mogelvang, L. Maage, H. Scharling, P. Schnohr, P. Sogaard, J. F. Rehfeld, and J. S. Jensen Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction Eur. Heart J., December 2, 2006; 27(24): 3004 - 3010. [Abstract] [Full Text] [PDF]
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A. Clerico, G. C. Zucchelli, A. Pilo, and M. Emdin Clinical Relevance of Biological Variation of B-Type Natriuretic Peptide Clin. Chem., May 1, 2005; 51(5): 925 - 926. [Full Text] [PDF]
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F. S. Apple, M. Panteghini, J. Ravkilde, J. Mair, A. H.B. Wu, J. Tate, F. Pagani, R. H. Christenson, A. S. Jaffe, and on Behalf of the Committee on Standardization of M Quality Specifications for B-Type Natriuretic Peptide Assays Clin. Chem., March 1, 2005; 51(3): 486 - 493. [Abstract] [Full Text] [PDF]
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