Elsevier

Heart Failure Clinics

Volume 10, Issue 3, July 2014, Pages 471-479
Heart Failure Clinics

Novel Biomarkers in Heart Failure with Preserved Ejection Fraction

https://doi.org/10.1016/j.hfc.2014.04.005Get rights and content

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Key points

  • Heart failure with preserved ejection fraction (HFPEF) is a common subtype of congestive heart failure for which therapies to improve morbidity and mortality have been limited thus far.

  • Numerous biomarkers have emerged over the past decade demonstrating prognostic significance in HFPEF, including natriuretic peptides, galectin-3, soluble ST2, and high-sensitivity troponins.

  • These markers reflect the multiple mechanisms implicated in the pathogenesis of HFPEF, and future research will likely use

Background

Heart failure (HF) is a global epidemic, defined as an abnormality of cardiac function leading to the inability to deliver oxygen at a rate adequate to meet the requirements of tissues.1 It is truly a clinical syndrome of symptoms and signs resulting from this cardiac abnormality. Over the past decade, further characterization into 2 entities has occurred: HF with preserved ejection fraction (HFPEF) and HF with reduced ejection fraction (HFREF). HFPEF, previously termed diastolic HF,

Pathophysiology

The pathophysiology of HFPEF is controversial and remains poorly understood. Originally, HFPEF was thought to be a primary manifestation of diastolic dysfunction of the left ventricle. However, patients with HFREF are known to also commonly have impaired ventricular relaxation.14, 15 As already mentioned, the primary mechanism of left ventricular (LV) dysfunction is based on structural remodeling and endothelial dysfunction, lending itself to LV stiffness, and increased left atrial pressure.

Therapy

Results from the few randomized controlled trials attempting to find effective therapeutic agents for patients with HFPEF have been limited and mostly discouraging. What has been established as effective includes primarily managing decompensated HFPEF with diuretics to improve fluid status and symptom control. With respect to angiotensin-converting enzyme inhibitors, the PEP-CHF trial demonstrated no significant mortality or rehospitalization benefit with perindopril.30 The CHARM-Preserved

Natriuretic Peptides

The natriuretic peptides (NPs) are the cornerstone biomarker in congestive HF (CHF). Many of the details of the role of NPs are covered in an article by Florea and Anand.35 The Breathing Not Properly trial originally helped establish the role of B-type natriuretic peptide (BNP) in the diagnosis of CHF.36 BNP and the N-terminal prohormone BNP (NT-proBNP) have been shown in numerous trials to be an excellent tool for ruling out CHF as a cause of acute dyspnea. Aside from a strong negative

Future directions

The future of biomarkers and their utility in HF is very promising, starting with the potential for using biomarkers as end points in trials. Biomarkers serve as surrogates for various pathophysiologic mechanisms, and there are potential benefits in using them as trial end points.84 Advantages include the ability to obtain quick and early data, as well as possibly better understand the nature of the disease.76 However, the counterargument against using biomarkers as trial end points includes

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