Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Clin Pharmacol Ther. 2013 Oct;94(4):468-79. doi: 10.1038/clpt.2013.139. Epub 2013 Jul 15.
Understanding of chronic heart failure (HF) has progressed from the concept of a purely hemodynamic disorder to that of a syndrome that results from dysfunction in interconnected molecular pathways. As a result, the focus of research investigations and clinical care has shifted to measurement and modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers provide a window into the pathophysiology of chronic HF and therefore have important therapeutic implications. However, the use of biomarkers in the treatment of HF remains in its infancy. This is partly a result of shortcomings in research studies and a dearth of biomarker-guided clinical trials. In this review, we summarize the potential therapeutic implications of promising biomarkers that uniquely capture the molecular dysfunction that occurs in chronic HF. We discuss the need for strict statistical standards in biomarker studies, provide an overview of biomarker-guided clinical trial design, and discuss the therapeutic potential of a multimarker-based strategy.
对慢性心力衰竭（HF）的认识已经从纯粹的血流动力学障碍的概念发展到由于相互关联的分子途径功能障碍而导致的综合征。因此，研究调查和临床护理的重点已经转移到对适应不良的分子过程的测量和修正上。越来越多的证据表明，分子生物标志物为慢性 HF 的病理生理学提供了一个窗口，因此具有重要的治疗意义。然而，生物标志物在 HF 治疗中的应用仍处于起步阶段。这在一定程度上是由于研究的缺陷和缺乏基于生物标志物的临床试验。在这篇综述中，我们总结了有前途的生物标志物的潜在治疗意义，这些生物标志物独特地捕捉到了慢性 HF 中发生的分子功能障碍。我们讨论了在生物标志物研究中严格的统计标准的必要性，提供了生物标志物指导的临床试验设计概述，并讨论了基于多标志物策略的治疗潜力。
