Old and new biomarkers of heart failure

Heart failure (HF) may be considered as the fatal finishing line of all cardiovascular disorders. Despite advances in the understanding and treatment, it still has a poor prognosis. Heart failure is a syndrome, rather than a primary diagnosis, which results from any structural or functional cardiac disorder that impairs the ability of the heart to support the physiological circulation. This is sustained by a chronic imbalance in the neurohormonal control of circulation. Unfortunately, there is no single diagnostic test for HF, and the accuracy of diagnosis by clinical means only (i.e. a combination of history, physical examination and appropriate investigations) is often inadequate. Diagnosis and risk stratification depend on the availability of accurate, and effective markers of either risk or disease. There is an increasing interest in the development of new biomarkers, and a great number of laboratory tests have recently been proposed. The goals of this 'commentary' are to (i) briefly discuss the characteristics of an ideal HF biomarker; (ii) describe the analytical performance and clinical relevance of currently available biomarker assay methods, (iii) evaluate newer biomarkers and finally, (iv) design a scheme to optimize the search for efficient diagnostic and prognostic biomarkers for HF.