Are Multiple Biomarker Testing Strategies Ready for Prime Time in Heart Failure?

Abstract

In patients with heart failure, the promise that biomarkers may provide has been extensively explored. Although brain natriuretic peptide (BNP) had been proposed as a potential tool for screening patients with left ventricular systolic dysfunction, subsequent studies suggested that the biomarker had little benefit in this context.1 Indeed, the utility of BNP is perhaps most valuable when used in the more restricted and specific diagnostic context of the dyspneic patient without a clear-cut diagnosis.2 The potential utility of biomarkers for heart failure has been explored to a greater degree in the context of prognosis.3–5 However, the utility of any biomarker should be demonstrated to be incrementally better when compared to optimal clinical prediction models and other potential candidate biomarkers.6 Prior studies evaluating the prognostic utility of biomarkers in heart failure were often limited in this context. Article see p 393 In this issue of Circulation: Heart Failure , Dunlay et al7 have published the results of a study from the Mayo Clinic examining multiple biomarkers when used for prognostication of community patients with heart failure. Three currently available biomarkers, including C-reactive protein (CRP), troponin T, and BNP were examined in comparison with a clinical model for mortality risk. The combination of biomarkers, and in particular CRP and BNP, increased significantly the discrimination of the model for prediction of 1-year mortality risk, suggesting the exciting possibility that this combination of biomarkers may be clinically …