Kardiale Biomarker und ihre klinische Bedeutung

Biomarker bieten quantitative, leicht verfügbare Informationen über Krankheitsprozesse im klinischen Alltag. Ihr Nutzen in der kardiovaskulären Medizin ist durch die Troponine und natriuretischen Peptide belegt. Diese und weitere in Entwicklung befindliche Biomarker haben großes Potenzial für die frühe Erkennung und personalisierte Therapie kardiovaskulärer Erkrankungen.

Abstract

Cardiac biomarkers are an integral, guideline-recommended part of the diagnosis and follow-up of heart diseases. High sensitivity tests for troponin I or T allow for the early diagnosis of myocardial infarction. Rule-in and rule-out algorithms based on the dynamic of plasma concentrations in the first hour after admission improve safe, evidence-based decision making for patients with acute chest pain. Low concentrations of brain natriuretic peptides (BNP or NT-proBNP) reliably exclude heart failure. Elevated BNP/NT-proBNP concentrations are part of the definition of all types of heart failure but require additional tests to diagnose heart failure. Chronic elevations of troponins and BNP/NT-proBNP identify subpopulations at increased risk of cardiovascular events even in the absence of manifest cardiac disease. Whether and how this risk can be reduced requires further evaluation. Several novel biomarkers were recently discovered and characterised. Their place in cardiovascular medicine has yet to be defined.

Kernaussagen

• Die kardialen Biomarker Troponine und natriuretische Peptide sind heute fester Bestandteil der Diagnostik und Verlaufskontrolle kardialer Erkrankungen.

• Hochsensitive Tests für Troponin I oder T erlauben die frühe Diagnose eines Myokardinfarktes. Dabei kommt insbesondere der Erfassung der frühen Dynamik der Plasmakonzentrationen Bedeutung zu: im Sinne einer Bestätigung („rule-in“) oder eines Ausschlusses eines Infarkts („rule-out“).

• Niedrige BNP- oder NT-proBNP-Konzentrationen schließen eine Herzinsuffizienz sicher aus. Erhöhte Werte gehören inzwischen zur Leitlinien-Definition einer Herzinsuffizienz, sind allein aber nicht geeignet, die Diagnose sicherzustellen.

• Chronische Erhöhungen von Troponin- und BNP-Konzentrationen sind auch ohne manifeste kardiale Erkrankungen prognostisch ungünstig. Studien müssen klären, welche praktischen Konsequenzen dies hat.

• Weitere Biomarker werden aktuell in ihrer Bedeutung für die kardiovaskuläre Medizin erforscht.

Schlüsselwörter

kardiovaskuläre Biomarker - Troponin I/T - BNP/NT-proBNP - Herzinfarktdiagnostik - Herzinsuffizienz - neue Biomarker

Keywords

cardiovascular biomarkers - Troponin I/T - BNP/NT-proBNP - myocardial infarction - heart failure - new biomarkers - circulating biomolecules

Publication History

Article published online:
27 April 2023

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