Page 12 - Biomarkers for risk stratification and guidance in heart failure

conditions,19 and incorrect diagnosis at the ED has been reported to be as high 1 as 20%,16 accurate risk assessment can help identifying those at highest risk for
events, that are in need for admission and further work up.
1.2 Risk assessment in dyspnea.
For many acute settings such as acute coronary syndrome20 and pulmonary embolism,21 a risk score for short-term risk assessment has been developed. However for acute or recent onset of dyspnea, a short-term risk score has not yet been established.
Risk stratification for patients with acute dyspnea is a challenging task because of the wide variety of diagnoses involved, all with different pathophysiologic backgrounds. However, the use of biomarkers might be helpful for rapid and accurate risk assessment. Especially a combination of biomarkers reflecting different pathophysiologic backgrounds of diseases causing dyspnea might be beneficial. Both in patients with cardiac and non-cardiac dyspnea, biomarkers reflecting myocardial stretch,22,23 inflammation,24 renal failure,25,26 cardiac myocyte damage27 and fibrosis28 29 may have prognostic impact. Developing a risk score based on biomarkers reflecting the aforementioned pathophysiological processes (N-terminal pro-B-type natriuretic peptide \[NT-proBNP\] for myocardial stretch, \[Cys-C\] high-sensitivity C-reactive protein \[hs-CRP\] as a marker for inflammation, cystatin C for renal failure, high-sensitivity cardiac troponin T \[hs-c TnT\] for cardiac myocyte damage and galectin-3 \[Gal-3\] for fibrosis, respectively) may lead to accurate risk assessment in a period where risk for events is highest.
1.3 Guided therapy of Heart Failure
As HF-related morbidity and mortality are high, it is of importance not only to detect HF at its earliest stage, but also to identify those HF patients at highest risk for readmission or mortality. Current management of patients with HF is mainly based on clinical signs and symptoms. This approach allows clinicians to respond to worsening HF once it is recognized, but does not allow selection of individuals who are most likely to progress to increased morbidity and mortality.
The B-type natriuretic peptide (BNP) and its cleavage equivalent NT-proBNP have proven to be powerful diagnostic and prognostic markers in both acute and chronic HF.22,30-33 Natriuretic peptides may therefore be attractive biomarkers to guide management of HF and help select those patients in need of more aggressive therapy.
Introduction
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