Biomarkers
Even though heart failure (HF) is a global public health problem, its diagnosis is often quite challenging, especially in the initial stages. Biomarkers are useful instruments which could facilitate the early diagnosis and prompt therapy initiation in a p
- PDF / 379,636 Bytes
- 15 Pages / 439.37 x 666.142 pts Page_size
- 46 Downloads / 211 Views
13
Maria Dorobantu and Miruna Mihaela Micheu
13.1 Introduction Heart failure (HF) is a complex syndrome characterized by symptoms and signs caused by different cardiac dysfunctions leading to reduced cardiac output and/or elevated intracardiac pressures at rest or during exercise. The term HF refers only to patients with clinical symptoms excluding the early phases with no clinical expression. The prompt recognition of the abovementioned stage is thus extremely important, enabling timely therapeutic options to be initiated. Thus, strategies to facilitate the early diagnosis are a perpetual quest. One possible key to the previous question could be circulating biomarkers, substances capable to establish the diagnosis and/or prognosis of cardiac dysfunction with high sensitivity and specificity. If in HF with reduced ejection fraction (HFrEF), echocardiography represents a diagnostic investigation at one’s fingertips, for HF with preserved ejection fraction (HFpEF), the diagnosis is more challenging and relies mostly on elevated LV pressures at rest or during exercise, and consequently any new biomarker could ease diagnosis and treatment of these patients. Among the causes of HFpEF, hypertension (HT) is one of the most frequently encountered. If there are various biomarkers for HF in general, specific ones for HF in HT are only few and not well studied. In hypertensive subjects, it is mandatory to assess the subclinical organ damage, but specific biomarkers are essential to
M. Dorobantu (*) Clinical Emergency Hospital of Bucharest, Bucharest, Romania Cardiology Department, ‘Carol Davila’ University of Medicine and Pharmacy in Bucharest, Bucharest, Romania M. M. Micheu Clinical Emergency Hospital of Bucharest, Bucharest, Romania © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_13
199
200
M. Dorobantu and M. M. Micheu
facilitate the diagnosis of this preclinical phase. But not all biomarkers being evaluated in laboratory settings fulfill the required criteria to be translated into the clinics. Several prerequisites would be mandatory for a biomarker to meet: accuracy and reproducibility of the method, strong associations with the disease pinpointed after multiple studies, and the proof that biomarker-guided treatment really offers certain benefit for the patient [1]. The oncoming importance of the new emerging biomarkers is their inclusion by ACA/AHA in class IIB of recommendations for risk stratification in the management of HF [2, 3].
13.2 Biomarkers Biomarkers with proven value in HF in HT patients—or being still under evaluation—can be classified in different categories according to the main pathophysiological mechanism which they are linked to. In view of that, these biomarkers are categorized into markers related to fibrosis, inflammation, myocyte stress, and microRNAs. A summary of the most studied biomarkers in each category can be found in Fig. 13.1.
13.2.
Data Loading...
