Introduction on Biomarkers in Acute Heart Failure – Cardiac And Kidney
Ideally biomarkers provide the clinician with assistance in one or more of: (i) diagnosis, (ii) prognosis, (iii) choice and titration of therapy, (iv) monitoring progression of disease and (v) assessing response to treatment. The best-established biomarkers in acute decompensated heart failure (ADHF) are the B-type natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal of the prohormone brain natriuretic peptide [NT-proBNP]). Their application in the diagnosis of ADHF and in risk stratification in both acute and chronic HF (AHF/CHF) is now endorsed by all major international guidelines for the diagnosis and management of HF.1,2 This brief review will summarise the main evidence underpinning this status and also outline the shortcomings of B-type cardiac peptides as diagnostic aids in ADHF. Acute and chronic kidney dysfunction and injury frequently complicate, and confer a worse prognosis in, ADHF. The impact of kidney function upon the test performance of BNP/NT-proBNP in ADHF and the currently unmet need for reliable markers of acute kidney injury (AKI) in the context of ADHF are briefly outlined.