Biomarkers in heart failure

The meaning of the term biomarker has been standardized by a working group of the National Institutes of Health as "a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention". The ability of a biomarker to enhance the quality and efficacy of clinical care depends on several factors, including pretest probability, sensitivity and specificity, costs, benefits, risks, and even patient preference and alternatives. With the aim to better diagnose the multifactorial and complex syndrome of heart failure, research has led to discover many categories of potential pathophysiologic biomarkers for this debilitating disease. Such categories have been mainly designed by matching different molecules levels to different pathophysiological stages of chronic heart failure, and comprise biomarkers of inflammation, oxidative stress, extracellular-matrix remodeling, neurohormones, myocte injury and stress, with an additional group of new biomarkers not yet fully characterized. The quest for an ideal biomarker in heart failure is still underway, and several newly discovered, but also old and overlooked markers might prove their relevance. Since at present we cannot apply the application of the perfect marker, maybe combining different molecules will provide information compensating for the shortcoming of individual tests. The accumulated basic and clinical research experience, and the continuing exploration of the genome, coupled with the evolving disciplines of proteomics and metabolomics, ensure that there will be no shortage of newly discovered candidate biomarker molecules for the future.