Dr. Christian Mueller
During the last decades, biomarkers have become accepted tools in clinical practice including the management of patients with heart failure. This session brought together leading experts from Europe and the United States to highlight the clinical value of natriuretic peptides (NP), as the only well established biomarker in the diagnosis, risk-stratification and treatment monitoring of heart failure, as well as emerging data from novel potentially complementary markers. Although there is no widely accepted definition of what constitutes a biomarker, for the context of this session the speakers con-sidered a biomarker to be a protein or other macromolecule that is associated with a biological process or regulatory mech-anism. Therefore, measurement of this biomarker e.g. in blood might provide quantitative information regarding this biological process or regulatory mechanism that could be clinically helpful. Accurate biomarkers of heart failure are highly desirable tools for physicians to either improve their ability make an early and accurate diagnosis or to follow positive or negative changes as a result of therapeutic intervention. The ability of physicians to make earlier diagnoses is valuable because therapeutic interventions are available that can make a significant impact on pa-tient quality of life and cost of care. Annual costs of heart failure in Europe and the United States are estimated at $130 billion, 70% of which is due to hospitalisation. Half of heart failure patients are readmitted within 6 months and 10% are readmitted twice heart failure. Fewer readmissions by guided therapy methods could significantly reduce morbidity and costs. Dr. von Haehling explained that meanwhile three NPs have been well validated in multiple clinical settings and seem to provide similar diagnostic and prognostic value: B-type natriuretic peptide (BNP) and the amino terminal fragment of proBNP (NTproBNP), and midregional proANP (MR-proANP) quantifying NT-proANP. Dr. Maisel provided expert guidance on how to integrate the quantitative information provided by the NP with all other clinical information pertaining to the patient. BNP is a regulatory peptide with biological effects that counter-balance the pathophysiologic effects underlying heart failure. NPs as quantitative markers of heart failure that summarize the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction provide valuable information for risk stratification in patients with acute and chronic heart failure. Dr. Januzzi summarized the data from randomized studies that assessed the incremental value of biomarkers for risk prediction and management. In summary these data show that physicians are able to translate the information provided by serial measurements of NPs into appropriate changes in patient management. This summary is based on the observation of a substantial reduction in all-cause mortality reported in two independent meta-analyses. Adding the results of his recent PROTECT study, the arguments in favor of a NP-guided therapy seem now very strong. Still, the use of NPs for management is a matter of hot debate. Dr. Voors summarized emerging data for 5 novel biomarkers including renal markers, galactin-3, and advanced glycation endproducts. Some of these markers may serve clinicians in the identification of disease subtypes that may respond to specific interventions targeted to these signals. I personally was most interested in the work by his group with Kevin Damman as the first author assessing the impact of changes in volume status induced by cessation and restart of loop diuretics on tubular renal markers. These biomarkers and these studies might help to better understand cardio-renal interactions.
Biomarkers: are they of any value in heart failure?
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