Use of Novel and Conventional Biomarkers for Management of Patients With Heart Failure

Opinion statement

Investigation of the complex biochemical pathways that underlie heart failure (HF) has led to the recognition of multiple molecular markers that may help to characterize patients with this disease. Although a myriad of novel biomarkers are being studied, most attention continues to be focused on the natriuretic peptides, brain natriuretic peptide (BNP) and N-Terminal-proBNP (NT-proBNP). Numerous studies have established a role for these hormones in HF diagnosis and prognostication. More contentious has been their role in helping to guide HF management on a routine basis. This article aims to update the body of evidence surrounding conventional HF biomarkers and to highlight some emerging evidence on the use of novel markers. We believe that in select patients there may be a role for monitoring and cautious interpretation of HF biomarker levels to facilitate diagnosis, prognostication, and optimization of tailored therapy. However, there are not yet convincing data to suggest that routine hormone monitoring should be applied broadly and algorithmically to all HF patients. Moreover, to the extent that they are measured, HF biomarkers should serve only as a complement to—never as a substitute for—sound clinical judgment, watchful follow-up, and reliance on expert consultation when necessary.