Biomarkers in patients with acute dyspnoea: what for?

This editorial refers to ‘Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea’, by R.V. Shah et al. , doi:10.1093/eurheartj/ehs136 When patients present with acute dyspnoea, clinicians are faced with relevant issues. Particularly, making the right diagnosis and choosing the best therapies in a timely manner are crucial. To assess the latter, it may help to know the patient's risk, both short and long term, but the direct clinical benefit is less certain. History, physical examination, lab testing, and imaging techniques are cornerstones in order to come to the right conclusions, but they leave important open questions. Biomarkers circulating in the blood are attractive tools to improve care since they represent underlying pathophysiological processes and are relatively easy to measure. However, the question remains of what is their actual role in the clinical setting of acute dyspnoea ( Figure 1 ). Figure 1 Potential clinical usefulness of biomarkers (right-hand side) in the process of heart failure (left-hand side) with respect to diagnosis (green arrows), prognostic assessment (blue arrows), and therapy guidance (yellow arrows). The arrows point to the situation when biomarkers are applicable or of potential benefit. Level of evidence and clinical usefulness: ++, documented in large prospective trials, established, and useful; +, some data, probably useful; ††, well documented, but of unknown clinical benefit; †, less well established, unknown clinical benefit; 0, potential clinical benefit, but little or no data available; aStudy by Shah et al. ;13 brenal markers = serum creatinine, urea, uric acid, and to some extent cystatin C, newer renal markers such as KIM-1, or NGAL which are less well established; ca large number of other biomarkers have been shown to be related to poor outcome,11 of which (hs-)cTnT, haemoglobin, and creatinine are among …