Circulating Cardiac Biomarkers in Heart Failure: A Critical Link to Biomarker-Guided Therapy

Current clinical guidelines for the diagnosis, treatment, and prevention of heart failure (HF) are the incorporated measure of biomarkers, predominantly natriuretic peptides (NP), cardiac troponins, soluble ST2 (sST2), and galectin-3, all of which serve as surrogate diagnostic and predictive factors. Whether levels of these biomarkers, measured in a longitudinal manner in HF patients, retain their prognostic power over a course of HF therapy and support continuation of these treatments is not fully understood. The aim of this review is to summarise knowledge regarding the use of single and serial measures of cardiac, biological markers as a surrogate endpoint to predict HF-related clinical events. Cardiac biomarkers, predominantly N-terminal segment of brain natriuretic peptide (NT-proBNP) and sST2, are surrogate biomarkers for numerous clinical studies that have assumed a pivotal role in multiple biomarker strategies preceding HF-related outcomes. It has been suggested that biomarker-guided therapy with serial biomarker measures could be a powerful means to appraise composite risk score and predict HF-related outcomes based on therapeutic adjustment. In the future, large controlled clinical trials should be better designed for justification of an individualised strategy for HF therapy.