Natriuretic peptides and other biomarkers in chronic heart failure: from BNP, NT-proBNP, and MR-proANP to routine biochemical markers.

Cardiac biomarkers play an important role in heart failure. The family of natriuretic peptides, especially B-type natriuretic peptide, was identified as a valued diagnostic and prognostic tool. Not unexpectedly, the natriuretic peptides fail to fulfill all the criteria of an ideal biochemical marker. The quest for a single marker or a combination is therefore still on and several established, widely available biomarkers might have been overlooked in the field of heart failure. This review puts forward some of those biomarkers, and we speculate on the possible roles of combining two or more biomarkers. In that sense, any blood parameter including hemoglobin, cholesterol, uric acid, and recently identified proteins might function as a biomarker. Additionally, several biomarkers are discussed and we try to anticipate their diagnostic and prognostic value along with the natriuretic peptides and established biomarkers. Finally, we speculate about the potential of sharing the biomarkers over a variety of chronic diseases with similar pathophysiology.