Received on September 19, 2003
Accepted on November 11, 2003

Review

Strategies for Developing Biomarkers of Heart Failure

¹ Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40292
² Departments of Medicine/Cardiology and Physiology and Biophysics, University of Louisville School of Medicine, Louisville, KY 40292
³ Departments of Pathology and Laboratory Medicine and Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, KY 40292

^* To whom correspondence should be addressed. 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 is more than $20 billion dollars, 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. Strategies are considered in view of recent advances in our understanding of molecular biochemical derangements observed during cardiac failure, the concept of myocardial remodeling, and considering the heart as part of an endocrine system.

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.© 2004 American Association for Clinical Chemistry {hd1}Introduction and Demographics