Biomarker zur Risikostratifizierung der Herzinsuffizienz

Zusammenfassung

Aufgrund der Zunahme der Herzinsuffizienz in der Bevölkerung sind eine frühe Diagnostik, eine Risikostratifizierung und eine gute Therapiesteuerung nötig, nicht zuletzt, um die entstehenden volkswirtschaftlichen Kosten zu senken. Hierzu reichen die klinischen Parameter bei Weitem nicht aus und müssen durch Biomarker ergänzt werden. Die natriuretischen Peptide BNP und NT-proBNP sind als Biomarker für die Herzinsuffizienz seit Langem bekannt und ihre Aussagekraft durch viele Studien belegt, sodass sie auch in den internationalen Leitlinien berücksichtigt wurden. Durch die Entwicklung der hochsensitiven Tests können die kardialen Troponine bereits einen Beitrag zur Risikostratifizierung leisten. Weitere potenzielle Biomarker kommen aus den Bereichen und Organsystemen, die durch die Herzinsuffizienz beeinträchtigt werden. Um diese umfassend abzubilden, sollen in Zukunft mit Multimarkeransätzen weitere Verbesserungen erreicht werden.

Abstract

In order to reduce the increasing burden of heart failure it is necessary to establish the diagnosis, risk stratification and therapeutic strategies early in the course of the disease. Clinical judgement alone is not sufficient to meet these requirements and needs complementation by additional parameters. Biomarker like the natriuretic peptides BNP and NT-proBNP are well characterized in heart failure patients and are therefore implemented in current guidelines. In addition to that other biomarkers representing pathophysiologic changes induced by systemic effects of a decreased cardiac output are on the rise and may lead to the implementation of an integrated multimarker strategy for further improvement of patientʼs outcome.

Schlüsselwörter

Biomarker - Risikostratifizierung - Herzinsuffizienz - BNP - NT-proBNP - Troponin - Osteopontin - Multimarkerstrategie

Key words

biomarker - risk stratification - heart failure - BNP - NT-proBNP - Troponin - Osteopontin - multi marker strategy

• Literatur

• 1 Statistisches Bundesamt. Gesundheit im Alter. Wiesbaden: 2012
• 2 Wang CS et al. Does this dyspneic patient in the emergency department have congestive heart failure?. JAMA 2005; 294: 1944-1956
• 3 Green SM et al. Clinical uncertainty, diagnostic accuracy, and outcomes in emergency department patients presenting with dyspnea. Arch Intern Med 2008; 168: 741-748
• 4 McMurray JJ et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
• 5 Morrow DA, de Lemos JA. Benchmarks for the assessment of novel cardiovascular biomarkers. Circulation 2007; 115: 949-952
• 6 Braunwald E. Biomarkers in heart failure. N Engl J Med 2008; 358: 2148-2159
• 7 Tang WH et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: Clinical utilization of cardiac biomarker testing in heart failure. Circulation 2007; 116: e99-e109
• 8 Maisel AS et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161-167
• 9 Grewal J et al. Usefulness of N-terminal pro-brain natriuretic Peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction. Am J Cardiol 2008; 102: 733-737
• 10 Anand IS et al. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003; 107: 1278-1283
• 11 Brenden CK et al. Gray zone BNP levels in heart failure patients in the emergency department: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study. Am Heart J 2006; 151: 1006-1011
• 12 Di Somma S et al. Use of BNP and bioimpedance to drive therapy in heart failure patients. Congest Heart Fail 2010; 16 (Suppl. 01) S56-61
• 13 Felker GM et al. Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials. Am Heart J 2009; 158: 422-430
• 14 Latini R et al. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 2007; 116: 1242-1249
• 15 Tsutamoto T et al. Prognostic role of highly sensitive cardiac troponin I in patients with systolic heart failure. Am Heart J 2010; 159: 63-67
• 16 George J et al. Circulating matrix metalloproteinase-2 but not matrix metalloproteinase-3, matrix metalloproteinase-9, or tissue inhibitor of metalloproteinase-1 predicts outcome in patients with congestive heart failure. Am Heart J 2005; 150: 484-487
• 17 Rosenberg M et al. Osteopontin, a new prognostic biomarker in patients with chronic heart failure. Circ Heart Fail 2008; 1: 43-49
• 18 Peacock WF et al. Short-term mortality risk in emergency department acute heart failure. Acad Emerg Med 2011; 18: 947-958
• 19 Nickolas TL et al. Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study. J Am Coll Cardiol 2012; 59: 246-255
• 20 Anand IS et al. Serial measurement of growth-differentiation factor-15 in heart failure: relation to disease severity and prognosis in the Valsartan Heart Failure Trial. Circulation 2010; 122: 1387-1395
• 21 von Haehling S et al. Mid-regional pro-adrenomedullin as a novel predictor of mortality in patients with chronic heart failure. Eur J Heart Fail 2010; 12: 484-491
• 22 Ky B et al. Multiple biomarkers for risk prediction in chronic heart failure. Circ Heart Fail 2012; 5: 183-190