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  • Review Article
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Biomarkers in acute heart failure—state of the art

Nature Reviews Cardiology volume 9, pages 478–490 (2012)Cite this article

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Abstract

The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years. Representing a major burden on health systems, acute HF has increased the need for earlier diagnosis, better risk stratification, and cost-effective treatment to reduce rates of hospitalization. Biomarker-guided diagnosis and treatment have become essential, especially in the acute setting to which the majority of the patients with acute HF initially present. Studies clearly demonstrate the complexity of these patients, who commonly have multiple comorbidities necessitating an integrative approach. Several groundbreaking studies conducted in the past decade have demonstrated how biomarkers, individually or in combination, can outperform conventional laboratory tests used in the emergency department as well as in hospitalized patients with acute HF. In this Review, we will provide an update on biomarkers considered state of the art in the diagnosis and management of patients with acute HF.

Key Points

  • The symptoms and signs of acute de novo heart failure (HF) and acute decompensated HF have distinct underlying pathophysiology; however, they show little clinical variation on presentation

  • Presenting signs in patients with acute HF are often difficult to interpret on the basis of available laboratory tests

  • Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive marker of acute kidney injury in the early ischemic phase of acute HF

  • Procalcitonin can be used to differentiate between acute HF and superimposed pneumonia, to guide antibiotic treatment, and to predict adverse outcomes

  • Infective and inflammatory markers can provide strong evidence of multiorgan involvement in patients with acute HF, thus predicting short-term survival

  • Biomonitoring and multimarker strategies can improve patient outcomes, decrease length of hospital admission, and reduce hospitalization costs

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Figure 1: Biomarkers and their organ-specific release sites.
Figure 2: Proposed biomarker timeline.
Figure 3: A hypothetical paradigm for the treatment and hospital discharge of patients with ADHF.

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  1. Department of Medicine, Division of Cardiology, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, 92161, CA, USA

    Alan S. Maisel & Rajiv Choudhary

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R. Choudhary researched data for the article. Both authors contributed to the discussion of the content and wrote the article. A. S. Maisel reviewed and edited the manuscript before submission.

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Correspondence to Alan S. Maisel.

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Competing interests

A. S. Maisel has acted as a consultant for Alere, Critical Diagnostics, and EFG Diagnostics; has received honoraria from Alere; and has received grants/research support from Abbott Laboratories, Alere, Nanosphere, Novartis, and Thermo Scientific B·R·A·H·M·S. R. Choudhary declares no competing interests.

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Maisel, A., Choudhary, R. Biomarkers in acute heart failure—state of the art. Nat Rev Cardiol 9, 478–490 (2012). https://doi.org/10.1038/nrcardio.2012.60

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