Novel biomarkers in heart failure. What they add in daily clinical practice?

Novel biomarkers in heart failure.What they add in daily clinical practice?Cardiovascular diseases (CVD) is not only the leading cause of morbidity and mortality but diagnosis and management is often hampered by the atypical, or subtle symptoms and signs.1e4 In this settings, easily measured biomarkers which can provide additive diagnostic and prognostic information over clinical evaluation are of importance.5e8 This is particularly true in acute settings such as in acute myocardial infraction or acute heart failure (HF), where a definitively, timely and appropriate diagnosis may change patients' prognosis. 9,10 pecially, cardiac troponins and natriuretic peptides which may be even consider pre-requisite for the diagnosis. 9, 10In HF settings natriuretic peptides beyond diagnostic information may be used for prognostic purposes, to guide discharge from hospital while little evidence exists for their role in out of hospital treatment management. 10,11 ardiac troponins can also be used to exclude acute myocardial infraction as the underlying etiology of decompensate heart failure and with additive prognostic value. 10,11 owever, the exact role of novel biomarkers in other HF settings is challenged and little or no evidence exist for the additive clinical value of novel biomarkers associated with inflammation, infection, fibrosis, or neuro-hormonal axis activation (Table 1 and Fig. 1). 10,11 netheless, since diagnosis and management of HF remain challenging, study of biomarkers will continue to focus research interest not only as a clinical tool but also as a valuable tool to explore underlying pathophysiologic mechanisms.To this purpose in this issue of HJC Chen F. et al. provide data on the clinical significance on novel identified microRNAs in patients with HF. 20 MicroRNAs is a relative new family of biomarkers regulating several biological processes and associated with several cardiovascular conditions such as thrombosis, fibrinolysis, myocardial infraction, cellular energetics and of note HF.Especially, microRNAs 423-5p, À320a, À22, and À92b have been found in the past to be associated with HF. 21,22 To an exploratory analysis Chen F et al. identified that microRNAs À3135b, À3908 and -5571-5p are found elevated in patients with HF.Moreover, microRNAs À3135b and À3908 are expressed differently in patients with HF and preserve ejection fraction compared to patients with HF and reduce ejection fraction.Importantly, they also identified potential pathophysiologic pathways linking the expression of these microRNAs with HF and especially calcium signaling pathway, aldosteroneregulated sodium reabsorption, MAPK signaling pathway, mTOR signaling pathway and FoxO signaling pathway.However, these data can only consider as preliminary and should only be used to