Abstract
Heart failure (HF) is a complex disease in which cardiomyocyte injury leads to a cascade of inflammatory and fibrosis pathway activation, thereby causing decrease in cardiac function. As a result, several biomolecules are released which can be identified easily in circulating body fluids. The complex biological processes involved in the development and worsening of HF require an early treatment strategy to stop deterioration of cardiac function. Circulating biomarkers provide not only an ideal platform to detect subclinical changes, their clinical application also offers the opportunity to monitor disease treatment. Many of these biomarkers can be quantified with high sensitivity; allowing their clinical application to be evaluated beyond diagnostic purposes as potential tools for HF prognosis. Though the field of biomarkers is dominated by protein molecules, non-coding RNAs (microRNAs, long non-coding RNAs, and circular RNAs) are novel and promising biomarker candidates that encompass several ideal characteristics required in the biomarker field. The application of genetic biomarkers as genetic risk scores in disease prognosis, albeit in its infancy, holds promise to improve disease risk estimation. Despite the multitude of biomarkers that have been available and identified, the majority of novel biomarker candidates are not cardiac-specific, and instead may simply be a readout of systemic inflammation or other pathological processes. Thus, the true value of novel biomarker candidates in HF prognostication remains unclear. In this article, we discuss the current state of application of protein, genetic as well as non-coding RNA biomarkers in HF risk prognosis.
Highlights
Heart failure (HF) is a complex cardiovascular disease (CVD) in which the heart’s functional capacity is reduced, leading to failure in meeting the body’s blood and oxygen demand [1]
The authors were further able to prove H19’s essential HF-reversing effect. While these findings are backed-up by similar results on cardiac tissue level [209], validation of H19 as a circulating biomarker for HF prognostication is still pending. These findings indicate the potential use of long non-coding RNAs (lncRNAs) as prognostic circulating biomarkers for CVD—similar to some miRNAs
The identification and further exploration of biomolecules suitable as biomarkers for specific disease is a complex process, which requires numerous prerequisites to be met such as detectability in the circulation, reliable quantification methods, pathophysiologic relation to the suspected disease, and many more (Table 2)
Summary
Heart failure (HF) is a complex cardiovascular disease (CVD) in which the heart’s functional capacity is reduced, leading to failure in meeting the body’s blood and oxygen demand [1]. Biomarkers for Heart Failure Prognosis mortality rates associated with HF, early diagnosis of the first subclinical signs is essential to prevent severe outcomes. Reduced cardiac output due to impairment in left ventricular function leads to an activation of the neuro-hormonal system. The severity of HF is graded in accordance to the New York Heart Association (NYHA) classification I, II, III, and IV This gradation is based on patient clinical symptoms and effect of HF on their physical mobility. In addition to existing imaging diagnosis techniques, it is important to identify biological markers which focus on HF pathogenesis and molecular function that can aid in risk stratification and patient care (Figure 1). The ease of measurement of circulating protein biomarkers and the speed of assay results make them invaluable to HF diagnosis and prognosis
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