Scientists have identified that a combination of two more efficient applications of biomarkers of heart failure can promise an earlier diagnosis and improved treatment for patients.
Heart failure describes a syndrome of symptoms without a single diagnostic test.
But now, two studies suggest that a combination of two biomarkers may improve diagnosis and prognosis, and form the basis of optimal management of patients with heart failure.
The first study in Hull, UK, found that repeatedly measuring the well established biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP), once treatment has been optimized, provides stronger prognostic information than either the baseline value, the change in NT-proBNP, or other conventional methods of assessment.
The study involved 354 patients with chronic heart failure treated in a community-based heart failure program.
Indeed, NT-proBNP "was consistently the strongest independent prognostic marker at predicting death or unplanned cardiovascular hospitalizations after baseline or follow-up assessment," said the authors.
"NT-proBNP monitoring will enable the identification of patients who are not responding well to treatment or help flag those patients needing more aggressive management and monitoring," said first author Dr. Milos Kubanek from Castle Hill Hospital, Hull, UK.
"We found NT-proBNP to be a much stronger predictor of mortality and CV-hospitalization than echocardiographic measurements of, for example, ejection fraction, and therefore repeat NT-proBNP measurement may enable a reduction in the number of repeat echocardiograms.
"We suggest that the main role of conventional echocardiography should be to diagnose and differentiate the principal causes of heart failure, with subsequent NT-proBNP monitoring used to identify worsening disease and trigger further echocardiographic assessment. Given the relatively high cost of echocardiography compared to NT-proBNP, such a policy is likely to be cost effective," Kubanek added.
Another study from Sweden suggested that the combined application of two independently established biomarkers gives better prognostic information about the risk of cardiovascular mortality in heart failure patients than just one biomarker.
The study involved 464 elderly patients with the symptoms of heart failure followed up over a ten-year period Linkoping University Hospital.
Throughout that time serum measurements of the biomarker cystatin C (a marker of renal function) were taken, with results showing that those with levels within the highest quartile had almost three times the risk of cardiovascular death than those with levels in the first, second, or third quartiles.
However, when these measurements were combined with measurements of NT-proBNP, the mortality risk assessment was even more emphatic.
"Because the majority of patients with heart failure are elderly and often affected by other organ symptoms, including renal impairment, it is important to identify those at high risk, both for the provision of optimal treatment and the most effective use of health resources," Dr. Urban Alehagen from the Heart Center of Linkoping University Hospital, Linkoping, Sweden, and the study's first author, said.
"The use of a single blood test and the analysis of two biomarkers is one way of identifying those patients where health resources are best focused. More and more clinicians are using information from natriuretic peptides. However, it is now possible to expand the use of these biomarkers in clinical practice, and our study proposes one such potent combination," the researcher added.
A research article on these findings has been published in the European Journal of Heart Failure.