Multimarker approach for heart failure management: Perspectives and limitations

Heart failure (HF) is a major public health problem and the approach for an accurate individualization of HF risk and care should include a profile of laboratory data, in addition to clinical and imaging data. The possibility of identifying the most vulnerable patients is clinically important, especially considering that many therapeutic interventions are available today. This goal has not been yet reached although many novel biomarkers have been proposed and tested. The complexity of the biochemical network at the basis of HF pathophysiology clearly suggests that a single marker cannot reflect all the features of this syndrome, whereas the combined use of more indices would better characterize HF patients and create new options for their management, helping identify which patients to follow more closely. The multimarker approach, considering various biochemical pathways simultaneously, bases its robustness on a suitable choice of indices known to be individually associated with HF. The choice of biomarker combination is essential to the performance of the multimarker strategy. A major problem in selecting the biomarker profile is the proportional increase in economic burden; thus a "parsimonious" biomarker combination has to be used in a cost-effective evaluation. Statistical analysis and analytical performance of the different elements of the combination, in turn, may heavily influence results. This review summarizes the results obtained using a multimarker approach for HF risk stratification, for predicting HF incidence in a population, and evaluating the response to therapy. An insight into transcriptomic biomarkers, recently proposed for HF individual risk assessment, is also reported. A reliable selection of biomarkers for the careful management of HF patients is of pivotal importance in reducing healthcare costs without reducing patient care.