Predicting Heart Failure Phenotypes using Cardiac Biomarkers: Hype and Hope

Early risk stratification in heart failure (HF) might improve clinical outcomes via providing individualized treatment care. In this context, measuring plasma levels of cardiac biomarkers, i.e. natriuretic peptides, cardiac specific troponins, metabolomic intermediates, galectin-3, ST2, cardiotrophin-1, soluble endoglin, growth differentiation factor 15, microRNAs merges attractively. By now, the role of cardiac biomarker in prediction of early stage of HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) is not still fully understood. This review explores our current knowledge on the utility of cardiac biomarkers for reclassification of patients with different HF phenotypes. It has been reported that several biomarkers reflected the differentiation of fibroblasts into myofibroblasts that subsequently alter collagen turnover, cardiac fibrosis and inflammation; and might have diagnostic and predictive value in HFpEF and HFrEF. The best candidate biomarkers for detecting early stage HF weresST2, galectin-3, CT-1, and GDF-15. However, increased plasma concentration of these biomarkers was not specific for the HFpEF and HFrEF patient populations. Finally, more investigation is required to validate early diagnostic and prognostic value of novel biomarkers in HFpEF and HFrEF.