Heart failure (HF) may be considered as the fatal finishing line of all cardiovascular disorders. There is not a single diagnostic test for HF, and its diagnosis relies on clinical judgment based on a combination of history, physical examination, and appropriate investigations. For these reasons, the accuracy of diagnosis by clinical means alone is often inadequate. Despite the enormous advances in understanding and treatment that have taken place during the last 50 years, HF continues to have a poor prognosis. Diagnosis and risk stratification of patients with HF depend on the availability of specific, accurate, and effective disease or risk markers. Thus, there is an increasing interest in the development of new cardiovascular biomarkers, and, consequently, a great number of laboratory tests have recently been proposed for their assay. In this review, we briefly discuss the characteristics of an ideal HF biomarker and describe the analytical performance and clinical relevance of available biomarker assay methods, comparing their performances with that of an ideal biomarker for HF. Finally, we present a scheme to search for more efficient diagnostic and prognostic biomarkers for HF.
[Show abstract][Hide abstract] ABSTRACT: Validity of biomarkers may be affected if studies do not include certain features in their design. We evaluated whether translational research studies of potential biomarkers incorporated design features important for valid clinical associations.
We searched 10 journals for translational studies in six systemic autoimmune diseases published in 2004 through 2009. We included studies that reported associations between laboratory markers and the presence of disease, measures of disease activity, or prognosis. We examined the following design features: age, sex, and race matching; control for effects of treatment on expression of the biomarker; inclusion of patients with both early and late disease, or both active and inactive disease; longitudinal or cross-sectional design; and use of validated activity and damage measures.
Among 170 articles, 156 articles examined potential biomarkers for diagnosis, 37 for disease activity assessment, and nine for prognosis; 67 were studies of rheumatoid arthritis (RA); 48, of systemic lupus erythematosus; and 41, of other diseases. Gene-expression profiles were the most commonly examined potential biomarkers (n = 51). Fewer than one half of studies incorporated study-design features important for valid clinical associations. Only 47.4% of studies of biomarkers for diagnosis had groups that were age-matched, 45.5% were sex-matched, and 35.3% controlled for treatment. Studies that examined biomarkers in histologic samples and studies of RA were less likely to include important design features.
Fewer than one half of translational studies of potential biomarkers incorporated design features needed for valid interpretation of clinical associations. Attention to these features could reduce false-positive and false-negative associations.
[Show abstract][Hide abstract] ABSTRACT: A recent approach for the management of chronic obstructive pulmonary disease (COPD) is the measurement of systemic biomarkers. The aim of this study was to evaluate the usefulness of mid regional pro-atrial natriuretic peptide (MR-proANP) to predict short and long term prognosis.
We included 318 COPD patients: 46 in a stable phase, 217 undergoing an exacerbation and 55 with pneumonia. Serum samples were collected at admission. For 20 exacerbated patients, we also collected a second sample one month later. MR-proANP was measured by an inmunofluorescent assay.
Statistically higher levels of MR-proANP were found in patients with pneumonia when comparing to patients in the stable state (p=0.031). For those patients with paired samples, MR-proANP decreased statistically one month later (p=0.027). MR-proANP showed significant lower levels in exacerbations with isolation of pathogenic bacteria (p=0.011). MR-proANP levels were higher in patients that died within one month, decreasing as long as the moment of death occurred later on (p=0.163).
The identification of exacerbation etiology by means of MR-proANP is not clinically reliable. Levels of MR-proANP vary depending on the clinical status, being higher during pneumonia in comparison to the stable state. MR-proANP levels were higher in patients that died within one month after the exacerbation episode.
Clinica chimica acta; international journal of clinical chemistry 02/2011; 412(5-6):470-5. DOI:10.1016/j.cca.2010.11.032 · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute or destabilized heart failure (DHF) is characterized by new or worsening signs and symptoms of heart failure leading to admission to an emergency department. Biomarkers may support the diagnosis, the prognosis and the management of DHF patients. The aim of this review article is to discuss and evaluate the clinical usefulness of both recognized and potential new biomarker tests for use in heart failure.
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