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Prognostic Factors in Chronic Heart Failure

A Review of Serum Biomarkers, Metabolic Changes, Symptoms, and Scoring Systems

Prognostische Faktoren bei chronischer Herzinsuffizienz. Eine Übersicht zu Biomarkern, metabolischen Faktoren, Symptomatik und Score-Systemen

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Abstract

Decision-making in the care for patients with chronic heart failure (CHF) has become increasingly difficult. The many available therapeutic strategies and novel treatment modalities with borderline or modest benefit call for careful risk stratification in patients with CHF. Rather than relying on highly sophisticated and expensive procedures, we may find routinely available parameters of clinical value. This review considers the importance and validity of serum biomarkers (like natriuretic peptides, uric acid, lipoproteins, and cytokines), metabolic changes (like insulin resistance or body mass index), patient measures of symptom status and exercise capacity, as well as prognostic scoring systems. There is limited evidence that the use of prognostic markers to make treatment decisions improves the outcome in CHF. Many studies still need to be done to this end.

Zusammenfassung

Therapieentscheidungen bei Patienten mit chronischer Herzinsuffizienz werden zunehmend schwieriger, da es viele neue Behandlungsoptionen gibt. Um neue Behandlungsformen gezielt anwenden zu können, sind Informationen zur Prognoseverbesserung notwendig. Diese prognostischen Marker sollten im Idealfall einfach zu messen und preiswert sein. Prognosemarker können Biomarker (wie natriuretische Peptide, Harnsäure, Serumlipoproteine oder Zytokine), Stoffwechselmarker (wie die Insulinsensitivität oder der Body-Mass-Index), Marker der Symptomatik und der Leistungsfähigkeit oder Prognosescores sein. Es gibt wenig Evidenz, dass die Bestimmung der Prognose herzinsuffizienter Patienten im Rahmen von Therapieentscheidungen die Ergebnisse verbessert. In diesem Forschungsbereich sind noch viele Studien notwendig.

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  1. Division of Cardiology, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia

    Mitja Lainscak MD, PhD, FESC

  2. Division of Applied Cachexia Research, Department of Cardiology, Campus Virchow Clinic, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Mitja Lainscak MD, PhD, FESC & Stefan D. Anker

  3. Assistant Professor of Internal Medicine, Division of Cardiology, University Clinic of Respiratory and Allergic Diseases, Golnik 36, 4204, Golnik, Slovenia

    Mitja Lainscak MD, PhD, FESC

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Correspondence to Mitja Lainscak MD, PhD, FESC.

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Lainscak, M., Anker, S.D. Prognostic Factors in Chronic Heart Failure. Herz 34, 141–147 (2009). https://doi.org/10.1007/s00059-009-3211-z

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