Circulating MicroRNAs as Biomarkers of Accelerated Sarcopenia in Chronic Heart Failure

Background:Sarcopenia is a critical finding in patients with chronic heart failure (CHF). However, the search for a definitive biomarker to predict muscle and functional decline in CHF remains elusive.Objectives:We aimed to correlate the circulating levels of selected miRs with the indexes of sarcopenia during healthy aging and in patients with CHF.Methods:We analyzed the association of circulating microRNAs (miRs) levels including miR-21, miR-434-3p, miR424-5p, miR-133a, miR-455-3p and miR-181a with sarcopenia indexes in male, 61–73 years old healthy controls and patients with CHF (N = 89–92/group).Results:Patients with CHF had lower hand-grip strength (HGS), appendicular skeletal mass index (ASMI) and physical capacity than healthy controls. Circulating miR-21 levels were higher and miR-181a, miR-133a, miR-434-3p and miR-455-3p levels were lower in patients with CHF than healthy controls. Among the sarcopenia indexes, HGS showed the strongest correlation with miR-133a while ASMI showed the strongest correlations with miR-133a, miR-434-3p and miR-455-3p. Among the miRs, miR-434-3p showed the highest area under the curve in testing for sensitivity and specificity for CHF. These changes were associated with higher expressions of the markers of inflammation, oxidative stress and muscle damage in CHF patients.Conclusion:Taken together, our data show that circulating miRs can be useful markers of muscle health and physical capacity in the sarcopenic elderly with CHF.     

Circulating Biomarkers in Patients with Heart Failure and Preserved Ejection Fraction

Patients with heart failure with preserved ejection fraction (HF-PEF) comprise a growing proportion of the overall HF burden. The pathophysiology of HF-PEF is complex, and relates to the interplay between cardiac risk factors (notably diabetes/insulin resistance, hypertension), systemic inflammation, and comorbid medical illness (e.g. chronic kidney disease) that conspire to promote endothelial dysfunction, ventricular-vascular stiffening, and diastolic dysfunction. Efficient diagnosis and optimal therapy remain challenging in this population. Imaging, electrocardiographic, and circulating biomarkers, as well as pharmacogenetics, may help to facilitate HF diagnosis, stratify risk, and individualize therapy. In this review, we focus on established and emerging circulating biomarkers in HF-PE, including circulating biomarkers of myocyte stress, myocyte injury, renal function, systemic inflammation, and fibrosis. Such markers have contributed to better understanding of the pathophysiologic mechanisms relevant to HF-PEF, and may eventually help to facilitate more effective and personalized management of this syndrome.     

Heart Failure Biomarkers

Biomarker testing in patients with heart failure (HF) is rapidly expanding. With high-quality research indicating its diagnostic and prognostic capabilities, biomarkers are excellent adjuncts to manage patients with HF. Their superiority lies mainly in their reflection of ongoing pathophysiological events at a cellular level. Monitoring biomarker levels has been shown to provide incremental information on the progression of disease, thus allowing to better tailor treatment and management. Several biomarkers have gained attention in the past decade and continuing research demonstrates the specificity of each biomarker to be used on its own or in combination to improve diagnostic accuracy. This review will provide an insight into the role of such biomarkers, which are widely studied in the setting of HF so as to delineate their role in diagnosing, prognosticating, and titrating HF therapy.     

心肌细胞自身抗体的研究进展

越来越多的研究表明，免疫反应参与了心力衰竭的发病，并且在患者的血清中检测到了特定的抗体，推测与心血管疾病相关的自身抗体可能参与心室重塑和／或心衰的病理生理过程。本文就心肌自身抗体在心力衰竭患者中的研究进展作一综述。     

心力衰竭生物标志物的研究进展

随着人们对心力衰竭病理生理过程的认识逐步加深,多种生物学指标的改变对于心力衰竭诊断和预后的价值不断被发现。在其发生和发展过程中,机体通过心肌牵张、基质重塑、肌细胞损伤、氧化应激、炎症反应、神经激素激活和肾功能不全等途径发挥重要作用,现从不同途径分析几种可能运用于临床诊断和评估患者预后的生物标志物,并对其近年的研究现状做一综述。     

心力衰竭标记物研究进展

生物标记物在心力衰竭中的应用正引起大家的关注。钠尿肽已纳入心力衰竭管理指南。心肌坏死标记物、炎症介质、细胞外基质、神经激素等同样与心力衰竭存在相关性,但这些指标对心力衰竭治疗的指导价值有待进一步明确。     

Novel Biomarkers in Acute Heart Failure

Heart failure goes beyond mechanical dysfunction and involves an interplay of multiple pathophysiologic mechanisms, including inflammation, tissue remodeling, neurohormonal and endocrine signaling, and interactions with the renal and nervous systems. This article highlights some novel biomarkers that may aid in diagnosis, treatment, and prognosis of acute heart failure, specifically focusing on ST2, endoglin, galectin-3, cystatin C, neutrophil gelatinase–associated lipocalin, midregional pro-adrenomedullin, chromogranin A, adiponectin, resistin, and leptin and their emerging clinical roles.     

Growth Differentiation Factor 15 in Heart Failure: An Update

Growth differentiation factor 15 (GDF-15) is a stress-responsive cytokine expressed in the cardiovascular system. GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. GDF-15 integrates information from cardiac and extracardiac disease pathways that are linked to the incidence, progression, and prognosis of heart failure (HF). Increased circulating levels of GDF-15 are associated with an increased risk of developing HF in apparently healthy individuals from the community. After an acute coronary syndrome, elevated levels of GDF-15 are indicative of an increased risk of developing adverse left ventricular remodeling and HF. In?patients with established HF, the levels of GDF-15 and increases in GDF-15 over time are associated with adverse outcomes. The information provided by GDF-15 is independent of established risk factors and cardiac biomarkers, including BNP. More studies are needed to elucidate how the information provided by GDF-15 can be?used for patient monitoring and formulating treatment decisions. Further understanding of the pathobiology of GDF-15 may lead to the discovery of new treatment targets in HF.     

Biomarkers in the Management of Heart Failure

Biomarkers, especially natriuretic peptides such as B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP), are a valuable addition to standard clinical assessment in the diagnosis and prognosis of heart failure (HF). Furthermore, there is an increasing amount of evidence suggesting that natriuretic peptide–guided HF management may improve mortality, morbidity, and cost effectiveness. This work focuses on the use of BNP or NT-proBNP for the outpatient management of patients with chronic HF.