Incorporating Common Biomarkers into the Clinical Management of Heart Failure
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BIOMARKERS OF HEART FAILURE (WHW TANG, SECTION EDITOR)
Incorporating Common Biomarkers into the Clinical Management of Heart Failure Meghana Halkar & W. H. Wilson Tang
Published online: 2 October 2013 # Springer Science+Business Media New York 2013
Abstract Heart failure is a prevalent and costly disease, and its management with polypharmacy is complex. Commonly available biomarkers primarily help to 1) establish or refute the diagnosis of heart failure; 2) help to determine the disease severity; and 3) identify adverse consequences of treatment. Although several of them are commonly ordered (such as electrolytes, renal and liver function), their use is primarily based on broad clinical experience rather than established evidence. The availability of cardiac-specific natriuretic peptide testing has provided an evidence-based breakthrough in our abilities to establish the diagnosis and severity of heart failure, yet the appropriate boundaries to guide management are still in refinement. Keywords Biomarker . Markers . Heart failure . NT-proBNP . BNP . Heart failure management . e GFR . Creatinine . Cystatin C . NGAL . Sodium . Hyponatremia . ESR . Natriuretic peptide . Anemia . Albuminuria . Renal insufficiency . Azotemia . Prognosis A biomarker represents a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention [1]. Objective methods of biomarker measurement in medicine have served their role over M. Halkar Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA W. H. W. Tang Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA W. H. W. Tang (*) 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA e-mail: [email protected]
the years by complementing the clinical scenario in helping understand the appropriateness of their use. With the increasing burden of heart failure and predicted future rise in the morbidity worldwide from it, a central quest has been to optimize the management with the incorporation of biomarkers with the goal to improve morbidity and mortality as well as to reduce overall health care costs. During the last decade, there has been substantial progress in the use of biomarkers in clinical management of heart failure, and a broad range of clinical biomarkers have been rigorously tested in different mechanistic domains (Fig. 1). In this article we will review the common biomarkers used at all steps in the diagnosis and management of heart failure, with a prime focus on those that are widely available to healthcare providers and measured from bio specimens in clinical laboratories.
Biomarkers for Diagnosis in Heart Failure Acute decompensated heart failure (ADHF) represents one of the most common causes of hospitalizations in the elderly population. This is also where natriuretic peptide testing first established its clinical utility in the diagnosis of heart failure following their pivo
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