van der Velde A Rogier, Meijers Wouter C, de Boer Rudolf A
Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Curr Heart Fail Rep. 2014 Sep;11(3):246-59. doi: 10.1007/s11897-014-0207-7.
Risk prediction in patients admitted with acute decompensated heart failure (ADHF) remains a challenge. Biomarkers may improve risk prediction, which in turn may help to better inform patients regarding short-term and long-term prognosis, therapy and care. Most data on biomarkers have been derived from patient cohorts with chronic heart failure. In ADHF, currently, risk tools largely rely on common clinical and biochemical parameters. However, ADHF is not a single disease. It presents in various manners and different etiologies may underlie ADHF, which are reflected by different biomarkers. In the last decade, many studies have reported the prognostic value of these biomarkers. These studies have attempted to describe a value for statistical modeling, e.g., reclassification indices, in an effort to report incremental value over a clinical model or the "gold standard". However, the overall incremental predictive value of biomarkers has been modest compared to already existing clinical models. Natriuretic peptides, e.g., (NTpro-)BNP, are the benchmark, but head-to-head comparisons show that there are novel biomarkers with comparable prognostic value. Multimarker strategies may provide superior risk stratification. Future studies should elucidate cost-effectiveness of single or combined biomarker testing. The purpose of this review was to provide an update on current biomarkers and to identify new promising biomarkers than can be used in prognostication of acute heart failure.
急性失代偿性心力衰竭（ADHF）患者的风险预测仍然是一项挑战。生物标志物可能会改善风险预测，进而有助于更好地为患者提供有关短期和长期预后、治疗及护理的信息。大多数关于生物标志物的数据来自慢性心力衰竭患者队列。目前在ADHF中，风险评估工具很大程度上依赖于常见的临床和生化参数。然而，ADHF并非单一疾病。它有多种表现形式，不同病因可能是ADHF的基础，这通过不同的生物标志物得以体现。在过去十年中，许多研究报告了这些生物标志物的预后价值。这些研究试图描述用于统计建模的值，例如重新分类指数，以便报告相对于临床模型或“金标准”的增量价值。然而，与现有的临床模型相比，生物标志物的总体增量预测价值并不大。利钠肽，例如（NTpro -）BNP，是基准，但直接比较表明存在具有相当预后价值的新型生物标志物。多标志物策略可能提供更好的风险分层。未来的研究应阐明单一或联合生物标志物检测的成本效益。本综述的目的是提供当前生物标志物的最新信息，并识别可用于急性心力衰竭预后评估的新的有前景的生物标志物。
