Biomarkers in the Management of Acute Heart Failure: State of the Art and Role in COVID-19 Era

Figures

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  Figure 1. (A) Schematic representation of European HF guidelines and The American College of Cardiology guidelines regarding biomarkers coupled with classes of recommendations and level of evidence; (B) studies involving the biomarkers. AHF, acute heart failure; ADHERE, Acute Decompensated Heart Failure National Registry; ACC/AHA, American College of Cardiology/American Heart Association; BNP, B‐type or brain natriuretic peptide; CORONA, Controlled Rosuvastatin Multinational Trial in Heart Failure; COACH, Coordinating Study Evaluating Outcomes of Advising and Counselling Failure; ESC, European Society of Cardiology; Gal‐3, galectin‐3; HF, heart failure; NP, natriuretic peptides; N/A, not applicable; NT‐proBNP, N‐terminal pro B‐type natriuretic peptide; PRIDE study, Pro‐Brain Natriuretic Peptide Investigation of Dyspnoea in the Emergency Department; sST2, soluble suppression of tumourigenicity; RELAX‐AHF trial, Relaxin in Acute Heart Failure trial.

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  Figure 2. Schematic representation of NPs upon myocyte stretching. ANP, atrial natriuretic peptide; BNP, B‐type or brain natriuretic peptide; NP, natriuretic peptides; NT‐proBNP, N‐terminal pro B‐type natriuretic peptide.

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  Figure 3. Schematic representation of troponin I and T release into the circulation upon myocyte necrosis or damage.

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  Figure 4. Schematic representation of ST2 and sST2 and their involvement in fibrosis and hypertrophy. IL‐33, interleukin‐33; ST2, suppression of tumourigenicity; sST2, soluble suppression of tumourigenicity.

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  Figure 5. Schematic representation of Gal‐3 role in cardiac remodelling. Gal‐3, galactin‐3.

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  Figure 6. Flow diagram demonstrating remote monitoring and controlling for in‐home patients with HF risks. HF, heart failure; sST2, soluble suppression of tumourigenicity.

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  Figure 7. Flow diagram demonstrating the usefulness of multimarker approach for finer patient's management and decision‐making process in the ED. BNP, B‐type or brain natriuretic peptide; ED, emergency department; Gal‐3, galectin‐3; NT‐proBNP, N‐terminal pro B‐type natriuretic peptide; sST2, soluble suppression of tumourigenicity; VAD, ventricular assist device.