CARDIOVASCULAR
Cardiac biomarkers:
identification and innovation
With candidates identified from different pathophysiological pathways,
new technologies for measurement and more perspectives of data integration,
transformation is occurring in the field of cardiac biomarkers
Damien Gruson
PhD EuSpLM FESC
Department of
Laboratory Medicine,
Cliniques Universitaires
St-Luc and Université
Catholique de Louvain,
Brussels, Belgium
Cardiovascular diseases represent a global burden
because of related high morbidity, high mortality
and a significant impact on health economies. 1
We all play a role in the fight against
cardiovascular diseases, and laboratory tests are
important to assist clinicians in the prevention,
diagnosis and prognosis of cardiovascular
diseases. Heart failure (HF) is the inability of
the heart to respond to the circulatory demand
of the organism. The main causes of HF are
hypertension and ischaemic and valvular injuries,
whereas toxic, metabolic or genetic origins are
less common. In addition to the initial
abnormality, secondary changes occur over the
course, leading to multi-organ impairment. 1,2
More than 20 million people worldwide are
estimated to suffer from HF. 1,2 HF is increasing
because of an ageing population, as a result of the
success in prolonging survival in patients having
coronary events, and the success in postponing
coronary events by effective prevention in those
at high risk or those who have already survived
a first event. There are several forms of HF (with
reduced left ventricular ejection fraction or with
preserved left ventricular ejection fraction)
challenging both the diagnosis and the risk
estimation pathways. 1 Understanding HF and its
related molecular pathways is fundamental
because it allows the identification of potential
new biomarkers for patients’ management and
potential innovative therapeutic approaches.
HF and biomarkers
Most of the biomarkers with potential
applications in diagnosis and prognosis derive
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HHE 2019 | hospitalhealthcare.com
from the neurohormonal response to the failing
myocardium. 2,3 Neurohormonal activation plays
a significant role in myocardial and multi-organ
adaptations to HF. The use of biomarkers for the
diagnosis of suspected HF patients is part of daily
procedures and testing for B-type natriuretic
peptide (BNP) and the biologically inactive
N-terminal fragment (Nt-proBNP) is included in
guidelines of scientific societies. Biomarkers may
also fulfil complementary information for the
evaluation of disease severity, prognosis
estimation and for treatment selection. 1–3
Natriuretic peptides, the standard of care
Natriuretic peptides are the most recognised and
used biomarkers for the diagnosis and monitoring
of HF. 1-3
The natriuretic peptide family features three
members: atrial natriuretic peptide (ANP); BNP;
and C-type natriuretic peptide (CNP). BNP is
synthesised in the ventricles as a 108-
prohormone undergoing a cleavage generating
the C-terminal 32 amino-acid active peptide
(BNP) and the inactive N-terminal fragment
(Nt-proBNP). BNP synthesis and release are
essentially stimulated by a ventricular stretch
due to pressure or volume overload. Natriuretic
peptides are sensitive markers of cardiac
dysfunction and useful biomarkers to rule out
HF in emergency departments and have also
value for risk stratification of HF because
their circulating levels show strong negative
correlations with left ventricular ejection
fraction and are related to the disease severity
(as determined using the NYHA classification).