★The significance of timely diagnosis and prognostic monitoring of heart failure

CCTV recently reported that the number of current cardiovascular disease patients in China is as high as 330 million, with its incidence and mortality rates still topping the list of common diseases, with two out of every five deaths die of cardiovascular disease, according to China Cardiovascular Health and Disease Report 2021 released by the National Cardiovascular Disease Center. The situation of prevention and control of cardiovascular diseases in China is still very serious.

Among the common cardiovascular diseases, heart failure (HF) is considered as a major public health challenge in the cardiovascular field in the 21st century. The incidence of heart failure remains very high. It is estimated that the number of patients with heart failure in China is as high as 8.9 million. The first reason is that heart failure is hard to detect, and once detected the condition is often more than serious (heart failure is a severe manifestation or late stage of various cardiovascular diseases). Therefore, how to more effectively help clinical patients with heart failure in early diagnosis, risk stratification, prognosis evaluation and management is the focus of current medical workers.

Currently, the diagnosis and evaluation of heart failure rely on history of disease, physical examination, laboratory tests, cardiac imaging and functional tests. Biomarkers can guide the diagnosis, prognosis, and efficacy monitoring of heart failure, and play a key role in the laboratory examination. The combined use of multiple biomarkers may be the way forward. 

★Clinical Portfolio Tests for Heart Failure Markers

As markers of hemodynamic instability or myocyte tension in heart failure, B-type brain natriuretic peptide (BNP) and N-terminal B-brain natriuretic peptide (NT-proBNP) are both helpful for the diagnosis and exclusion of heart failure and the stratification of heart failure severity, and have long been included in guidelines issued by various authoritative institutions. However, NPs (referring to BNP and NT-proBNP) are susceptible to interference such as renal insufficiency, obesity, atrial fibrillation, anemia as well as HFPEF, HFREF, pulmonary hypertension and right heart failure, which will affect the clinical evaluation of patients’ condition.

Numerous studies have shown that sST2 is an effective prognostic biomarker in heart failure patients; moreover, the level of sST2 does not seem to be significantly affected by age, sex, body mass index, renal function or atrial fibrillation, etc.^[3] Compared with NPs, sST2 has less intra-individual varition and relative variation,  which is appropriate for continuous measurement and is known as the “glycated hemoglobin” in the field of heart failure.