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Biomarker-Guided Therapy for Chronic Heart Failure

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Biomarkers in Cardiovascular Disease

Abstract

The interest in guided therapy for acutely decompensated and chronic heart failure using several biological markers, which vary according to the pathogenesis of cardiac failure, has been steadily increasing. The circulating levels of brain natriuretic peptide (BNP) and N-terminal prohormone of BNP (NT-pro-BNP) are routinely used in clinical practice to stratify the risk of patients with symptomatic chronic heart failure. This chapter discusses the goal of lowering concentrations of these markers and their continued suppression in the follow-up period as part of the current therapeutic approach to chronic heart failure. Although a recent European Society of Cardiology (ESC) guideline did not recommend biomarker-guided therapy based on BNP/NT-pro-BNP in the management of chronic heart failure patients, the American Heart Association/American College of Cardiology (AHA/ACC) clinical practice guidelines for heart failure have issued a class I and A-level of evidence for BNP/NT-pro-BNP, citing them as powerful tools to supplement clinical judgment in chronic heart failure management. However, this approach should aim for individualization of the treatment strategy. Likewise, several conceptual, methodological, and practical limitations of natriuretic peptide-guided therapy conflict with the contemporary strategic approach based on symptoms and echo-guided treatment of chronic heart failure. The clinically significant biological variability of natriuretic peptides result in a lower specificity than expected, higher cost, and slow time-course. In addition, the lack of conclusive scientific evidence over a long-term period of intensive scientific investigations and industry investment may indicate a need for new biological markers or novel combinations for multimarker predictive scores and guided therapy. The chapter considers the potency and clinical advantages of a novel strategic approach for CHF treatment based on serial measurements of biomarkers and creating optimal combinations of biological indicators with an aim to improve clinical outcomes, quality of life, and well-being for patients with cardiac failure.

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Abbreviations

ACC:

American College of Cardiology

ACEI:

Angiotensin-converting enzyme inhibitors

ACS:

Acute coronary syndrome

ADCHF:

Acutely decompensated chronic heart failure

ADHF:

Acutely decompensated heart failure

AHA:

American Heart Association

ANP:

Atrial natriuretic peptide

ARB:

Angiotensin receptor blocker

BNP:

Brain natriuretic peptide

CABG:

Coronary artery bypass grafting

CHF:

Chronic heart failure

COPD:

Chronic obstructive pulmonary disease

ESC:

European Society of Cardiology

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

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Authors and Affiliations

  1. Department of Internal Medicine, State Medical University of Zaporozhye, 26, Mayakovsky av., UA 69035, Zaporozhye, Ukraine

    Alexander E. Berezin

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  1. Alexander E. Berezin
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Correspondence to Alexander E. Berezin .

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Editors and Affiliations

  1. Department of Biomedical Science, Faculty of Science & Technology , University of Westminster, London, United Kingdom

    Vinood B. Patel

  2. Department of Nutrition and Dietetics, Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom

    Victor R. Preedy

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Berezin, A.E. (2016). Biomarker-Guided Therapy for Chronic Heart Failure. In: Patel, V., Preedy, V. (eds) Biomarkers in Cardiovascular Disease. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7678-4_1

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