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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 …

Purpose: Several studies have shown that heart failure (HF) patients with preserved (HFPEF) versus those with reduced ejection fraction (HFREF) are distinctly different with more comorbidities. They are older, more often female, more likely to have hypertension, atrial fibrillation (AF) and a higher body mass index (BMI). It is unclear to what extent age, gender differences and BMI explain the other differences between HFPEF and HFREF. Methods: All 123 HFPEF patients from TIME-CHF were matched 1:1 to 499 HFREF patients for age (80±7 vs 80±7,P=0.60), gender (66% vs 66% female) and BMI (26.7±5.4 vs 26.7±4.1, P=0.50). Results: HFPEF patients had more frequently hypertension and less frequently coronary artery disease as cause of HF compared to HFREF patients. Number of comorbidities reflected by the Charlson score was similar in both groups. Strikingly, AF was not more common in the HFPEF group. Other specific comorbidities, including COPD, diabetes, stroke, arthritis did also not differ between groups. Symptom severity assessed by NYHA class did also not differ between groups. Laboratory findings including creatinine, urea and liver enzymes were similar in both groups, except for haemoglobin and N-terminal brain natriuretic peptide. The pulse pressure, reflecting arterial stiffness, was significantly higher in HFPEF patients. View this table: Baseline characteristics Conclusion: After matching for age, gender and BMI, prevalence of comorbidities and symptom severity is strikingly similar in HFPEF vs HFREF suggesting that age, gender or BMI may largely explain the differences between HF-groups. This study confirms that hypertension is a more common underlying cause of HFPEF and suggests that vascular stiffness may play a role in pathophysiology of HFPEF.