Biomarkers: Their potential in the diagnosis and treatment of heart failure

The increasing use of cardiac biomarkers in the diagnosis and management of heart failure (HF) has led to their inclusion in clinical practice guidelines. Studies have demonstrated that natriuretic peptides and cardiac troponins are useful adjuncts in identifying patients with HF at high risk, and we now know that a number of factors influence biomarker levels, including age, renal failure, obesity, and comorbid conditions, and that these factors as well as biomarker assay variability need to be considered when interpreting the results of biomarker testing. The broader use of cardiac biomarker testing has been limited by the lack of consistent data to support a benefit of their use in triaging management decisions, and the majority of drug therapies and titration schedules for HF were developed prior to the availability of biomarkers. Nevertheless, natriuretic peptide testing has been widely adopted, with recent guidelines supporting its use in the diagnosis of acute HF, especially in the setting of clinical uncertainty, as well as in assessing disease severity and prognosis. This review summarizes the data on traditional cardiac biomarkers and describes how the latest investigations have shaped the recommendations in the latest clinical practice guidelines.