Table 2.
Advantages and disadvantages of current biomarkers in HF
| Biomarker | Correspondence to basic pathophysiological mechanism/triggers | Current role in HF | Advantages | Disadvantages |
|---|---|---|---|---|
| NPs | Biomechanical stress, ischemia/ necrosis/reperfusion damage, fluid overload | Rule out HF. Risk stratification of HF. Prediction of all-cause and CV mortality. POC management. |
Independent predictor of high risk of HF, HF occurrence and progression, HF outcomes and death. Available for POC management and consequent measures in follow-up. Cost-effective diagnostic workup of newly suspected HF |
Respectively high biological variability. Renal clearance. Different cut-off points for various HF populations depending on CV risk factor presentation, age, and gender. Dependence of diagnostic reliability from co-existing CV and non-CV conditions |
| hs-cTn | Myocardial necrosis | Prediction of HF occurrence. Prediction of all-cause and CV mortality. |
Independent predictor of poor clinical outcomes. Available for continuous monitoring. Able to improve predictive value of NPs. Available for multiple-marker strategy for risk stratification. |
No relation between an effect of OGBM and changes of hs-cTn. Optimal plasma cut-off point under question. Gender-specific effects. |
| H-FABP | Myocardial necrosis | Independent predictor of all- cause and CV mortality. | Peak concentrations independently predict HF occurrence. | No strong evidence in large clinical trials. |
| GSTP1 | Myocardial necrosis, inflammation, apoptosis | Independent predictor of ACR. | Peak concentrations independently associated with susceptibility of cardiac dysfunction. | No strong evidence in large clinical trials. |
| Galectin-3 | Extracellular fibrosis and inflammation | Alternative stratification at higher risk of CV death and HF manifestation. | Peak concentrations independently associated with elevated risk of all-cause mortality, CV mortality, and HF-related outcomes. | Lack of dynamics during therapy. Low diagnostic accuracy for HF. Predictive value for readmission lower than that of NT-proBNP. Cut-off depends on age and gender. |
| sST2 | Extracellular fibrosis and inflammation | Alternative stratification at higher risk of all-cause mortality, CV death, and HF manifestation. | Peak concentrations independently associated with elevated risk of all-cause mortality, CV mortality, and HF-related outcomes. Available for serial measures and guided therapy. | The concentrations at discharge exert higher predictive potency than at admission. |
Abbreviations: ACR, adverse cardiac remodeling; HF, heart failure; CV, cardiovascular; hs-cTn, high-sensitivity cardiac troponin; H-FABP, heart-type fatty acid-binding protein; GSTP1, glutathione transferase P1; NPs, natriuretic peptides; NT-proBNP, N-terminal brain natriuretic pro-peptide; OGBM, optimal guide-based management; POC, point-of-care; sST2, soluble isoform of suppression of tumorigenicity 2.