Diagnostic biomarkers in cardiovascular disease: the proteomics approach

This editorial refers to ‘Unbiased plasma proteomics for novel diagnostic biomarkers in cardiovascular disease: identification of quiescin Q6 as a candidate biomarker of acutely decompensated heart failure’, by A. Mebazaa et al. , doi:10.1093/eurheartj/ehs162 Identification of the correct diagnosis as early as possible after presentation at the Emergency Department is particularly important in patients with acute cardiovascular disease, as any delay in the appropriate therapeutic countermeasures may result in potentially life-threatening aggravation of the disease. The skills and analytical perception of the experienced clinician may doubtless be among the most important means to establish the right diagnosis and to initiate the correct therapy. While intuition is essential for any good doctor in the diagnostic work-up, objective and verifiable measures are increasingly required in the time of evidence-based guideline recommendations and of flow chart-guided decision trees. Thus, the era of biomarkers as qualitative, or—even better—quantitative indicators of the problem has emerged. Within less than two decades, biomarkers have been established as indispensable tools in acute cardiovascular diagnostics. Moreover, not only is the initial diagnostic decision increasingly based on biomarker evaluation, but also upstream (risk prediction) and downstream (prognostic estimation) characteristics of the disease and eventually therapeutic monitoring are increasingly relying on biomarker assessments. Technological advances in genetics, genomics, proteomics, and non-invasive imaging have led to increasing numbers of biochemical factors and variables being tested for their potential role as biomarkers, and hardly a week goes by without a novel biomarker being proposed for clinical use as diagnostic, prognostic, or therapeutic guidance.The critical evaluation of the multitude of proposed biomarkers is increasingly important in order to identify those with the strongest, …