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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). For example, among healthy individuals, BNP concentrations average <=10 pg/mL; interestingly, while NT-proBNP concentrations are often much higher than BNP in the presence of prevalent HF, in healthy individuals NT-proBNP is often as very low as BNP. After the first proof of principle for B-type natriuretic peptide (BNP) as a diagnostic aid for acute heart failure (AHF) was reported by Davis I et al i . in 1994,1 the Breathing Not Properly (BNP) study, published in 2002, ushered in a new era for natriuretic peptides (NPs) as companion biomarkers for the diagnosis of heart failure (HF).2 More than just a clinical trial with novel and favourable results, it revolutionized a whole field and introduced biomarkers and the molecular phenotyping of the heart to algorithms in use for HF diagnosis and management. The "Peptide for Life" Initiative: a call for action to provide equal access to the use of natriuretic peptides in the diagnosis of acute heart failure across Europe. [Extracted from the article]

The approval of new heart failure (HF) therapies has slowed over the past two decades in part due to the high costs of conducting large randomized clinical trials that are needed to adequately power major clinical endpoint studies. Several biomarkers have been identified reflecting different elements of HF pathophysiology, with possible applications in diagnosis, risk stratification, treatment monitoring, and even in the design of clinical trials. Biomarkers could potentially be used to refine study inclusion criteria to enable enrolment of patients who are more likely to respond to a therapeutic intervention, despite being at sufficient risk to meet pre‐determined study endpoint rates. When there is a close relationship between biomarker levels and clinical endpoints, changes in biomarker levels after a given treatment can act as a surrogate endpoint, potentially reducing the duration and cost of a clinical trial. Natriuretic peptides have been widely used in clinical trials with a variable amount of added value, which such variation being probably due to the absence of a close pathophysiological connection to the study drug. Notable exceptions to this include sacubitril/valsartan and vericiguat. Future studies should seek to adopt unbiased approaches for discovery of true companion diagnostics; with ‐omics‐based tools, biomarkers might be more precisely selected for use in clinical trials to identify responses that closely reflect the biological effects of the drug under investigation. Finally, biomarkers associated with cardiac damage and remodelling, such as cardiac troponin, could be employed as safety endpoints provided that standardization between different assays is achieved. [ABSTRACT FROM AUTHOR]

New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high‐sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin‐3, growth differentiation factor‐15 (GDF‐15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic‐based risk scores. We focused on guidance and assistance with daily clinical care decision‐making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials. [ABSTRACT FROM AUTHOR]