Division of Cardiology, Duke University School of Medicine, 2400 Pratt Street, Durham, NC 27705, USA.
Nat Rev Cardiol. 2012 Mar 27;9(6):347-59. doi: 10.1038/nrcardio.2012.37.
Understanding of chronic heart failure (HF) has progressed from a syndrome of disordered hemodynamics caused by alterations in the structure of the heart to one that involves intertwined molecular pathways in disarray. Accordingly, the assessment and treatment of patients with chronic HF has shifted from a focus on hemodynamics to modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers of disease could provide a unique window into the pathophysiology of chronic HF, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. The more 'traditional' biomarkers such as cardiac troponin, natriuretic peptides, and C-reactive protein have been studied in large cohorts of patients with chronic HF and have relatively established clinical applications. In this Review, we summarize the properties, clinical data, and potential applications of some emerging biomarkers that could uniquely indicate the level of biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occurs in chronic HF. We will also discuss the potential role for these biomarkers within a multimarker-based strategy that could, in the future, lead to better care for these patients.
对慢性心力衰竭（HF）的认识已经从因心脏结构改变而导致的血流动力学紊乱综合征发展为涉及紊乱的分子途径相互交织的病症。因此，慢性 HF 患者的评估和治疗已经从关注血流动力学转向纠正适应性差的分子过程。越来越多的证据表明，疾病的分子生物标志物可以为慢性 HF 的病理生理学提供独特的窗口，有可能提高我们预测不良结局的能力，提供新的药物靶点，甚至有助于评估治疗效果。已经在大量慢性 HF 患者的队列中研究了一些更“传统”的生物标志物，如肌钙蛋白、利钠肽和 C 反应蛋白，并且具有相对确定的临床应用。在这篇综述中，我们总结了一些新兴生物标志物的特性、临床数据和潜在应用，这些标志物可以独特地表明慢性 HF 中发生的生物力学拉伸、炎症、心室重构、心肌损伤和肾功能障碍的程度。我们还将讨论这些生物标志物在基于多标志物策略中的潜在作用，该策略未来可能为这些患者提供更好的护理。
