Theoretical and practical aspects of the use of biomarkers in chronic heart failure

Abstract

Heart failure (HF) remains a major problem in the modern healthcare system, which is a significant cause of hospitalizations, disability and mortality among the population. Left ventricular (LV) ejection fraction (EF) remains one of the main criteria for distribution HF patients into groups and on which the tactics of observation and treatment depend. The European Society of Cardiology distinguishes HF with preserved EF, HF with mid‑range EF, and HF with a reduced EF. Recently, to assess the risks, scientists have divided patients with HF into the following phenotypes according to the left ventricular ejection fraction: stable HF with preserved EF, stable HF with a reduced EF, HF with an increase in EF and HF with a decrease in EF. It has been proven that the lowest mortality rate in the HF group with an increase in EF is 17 %, and the highest mortality rate in the HF group with a decrease in EF is 43 %. From this point of view, special attention is drawn to the HF with mid‑range EF group, since the left ventricular ejection fraction in patients of this group changes more actively than in others (according to studies, after 1 year, the left ventricular ejection fraction increased in 44 % of patients, and decreased in 16 % of cases). To predict changes in the left ventricular ejection fraction, it is promising to determine the levels of biomarkers in the blood. It is known that NT‑proBNP is the most studied and informative cardiac biomarker. Its level in blood plasma correlates with the left ventricular ejection fraction, but focusing only on it is impossible to predict changes in the left ventricular ejection fraction. Moreover, the accuracy of NT‑proBNP determination in the diagnosis and prediction of heart failure is only 75 — 80 %. Other most researched biomarkers, such as galectin‑3, sST‑2, GDF‑15, and high‑sensitivity troponins, separately from each other, were ineffective in predicting changes in left ventricular ejection fraction. Therefore, a multi‑marker forecasting strategy is gaining popularity. The article talks about chronic heart failure (CHF), gives its definition and classification by the left ventricular ejection fraction. A review of modern studies demonstrating the relevance of predicting changes in left ventricular ejection fraction is given, data on the main promising cardiac biomarkers, such as NP, galectin‑3, sST‑2, GDF‑15 and highly sensitive troponins, their advantages and disadvantages in diagnosis and risk stratification in patients with CHF. Including the results of studies of furin, which is a pro‑BNP‑convertase and a promising cardiac biomarker as a component of a multimarker model for predicting the course of heart failure.