Biomarker Applications in Heart Failure Management
Summary
Heart failure remains a leading cause of global morbidity and mortality, driven by diverse pathophysiological processes that span myocardial injury, neurohormonal activation and extracellular matrix remodelling. Biomarkers offer a means to capture these processes in blood or tissue, aiding diagnosis, prognostication and therapeutic guidance. Traditional markers such as B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) reflect myocardial stretch and volume overload, while high-sensitivity troponin assays indicate ongoing myocyte injury. Emerging candidates include proteins of inflammation, fibrosis and senescence, as well as composite panels derived from proteomic and transcriptomic platforms. Integration of multi-marker and omics strategies can characterise individual risk profiles, monitor response to therapies such as neprilysin inhibition, and elucidate mechanistic pathways for novel interventions. Tailoring management to biomarker trajectories holds the promise of more precise and timely interventions across the spectrum of heart failure phenotypes.
Research from Nature Portfolio
Large-scale plasma proteomics in diverse cohorts has uncovered dozens of circulating proteins and co-regulation networks that predict incident heart failure independent of traditional risk factors. Proteomic data linked matricellular, inflammatory and senescence-associated proteins to disease onset, with Mendelian randomisation analyses supporting causal roles for selected candidates. In parallel, aptamer-based profiling across stages of established heart failure revealed dynamic modulation of immunological, complement, coagulation, natriuretic and matrix-remodelling pathways up to two decades before clinical presentation. Divergence of these proteomic signatures in advanced disease—and partial regression after heart transplantation—underscores both cardiac and systemic contributions to heart failure progression and highlights candidate molecules for early detection and targeted therapy.
Biomarker Applications in Heart Failure Management publication trend
The graph below shows the total number of articles in biomarker applications in heart failure management across all publications each year (not limited to Nature Index journals).
Technical terms
Biomarker: A measurable indicator of a normal or pathological process, or response to a therapeutic intervention.
Proteomics: The large-scale study of proteins and their interactions, functions and modifications in biological samples.
Natriuretic peptides (BNP, NT-proBNP): Hormones released by cardiac myocytes in response to increased wall stress, used for diagnosis and prognosis in heart failure.
Left ventricular ejection fraction (LVEF): The percentage of blood ejected from the left ventricle during systole, used to classify heart failure phenotypes.
Mendelian randomisation: A genetic epidemiology approach that uses inherited genetic variants as proxies for risk factors to infer causal relationships.
Extracellular matrix: The complex network of proteins and polysaccharides that provides structural and biochemical support to cells within tissues.
References
- Large scale plasma proteomics identifies novel proteins and protein networks associated with heart failure development. Nature Communications (2024).
- The diabetic myocardial transcriptome reveals Erbb3 and Hspa2 as a novel biomarkers of incident heart failure. Cardiovascular Research (2024).
- Biomarkers for the diagnosis and management of heart failure. Heart Failure Reviews (2021).
- Effects of Sacubitril/Valsartan on Biomarkers of Extracellular Matrix Regulation in Patients With HFrEF. Journal of the American College of Cardiology (2019).
- Profiling of the plasma proteome across different stages of human heart failure. Nature Communications (2019).
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