Biomarkers in Acute Heart Failure
Biomarkers in Acute Heart Failure
Primary Objectives

 1. Mid Region pro Adrenomedullin (MR-proADM) is superior to BNP for the prognosis of heart
 failure (HF) patients and adds incremental value in predicting outcomes for patients
 presenting to the Emergency Department (ED) with shortness of breath.

 2. Mid Region pro A-Type Natriuretic Peptide (MR-proANP) is non-inferior to BNP for the
 diagnosis of HF in patients presenting to the ED with shortness of breath.
The diagnosis of heart failure is often very difficult. Clinical history is often vague, and
 physical examination findings suffer from lack of specificity and sensitivity. For example,
 symptoms like shortness of breath and edema are often present in patients without cardiac
 disease, while elevated jugular venous pressure can be difficult to visualize and
 auscultation of a third heart sound can be challenging to hear, especially in an emergency
 room setting.

 Although BNP levels can sometimes help clarify the clinical picture when patients present
 acutely with shortness of breath, patients both with and without heart failure may have BNP
 values that fall into a "gray zone", where the diagnosis is still very much in question.
 Also, there can be difficulties in interpreting BNP levels in patients with renal
 dysfunction, patients with a high body mass index, and patients of advanced age.

 Investigative tests in the emergency department such as the electrocardiogram or chest x-ray
 are also non-specific for diagnosing heart failure. Tests such as echocardiography, while
 accurate in the assessment of left ventricular dysfunction, are expensive and are not always
 available on an emergent basis; furthermore, the presence of heart failure with normal
 systolic function (a.k.a. diastolic dysfunction) can complicate the interpretation of
 echocardiograms. Additionally, just because a patient has systolic dysfunction on an urgent
 echocardiogram does not mean that their acute dyspnea is due to heart failure, and so the
 test itself may not accurately reflect the acute situation at hand.

 Another difficult diagnostic dilemma arises when a patient with a history of heart failure
 presents with signs that could also be consistent an acute respiratory illness such as
 pneumonia. Often, patients with background heart failure have elevated BNP levels at
 baseline. In this setting, chest radiographs can be especially difficult to interpret when
 one must distinguish between edema and infiltrates, or possibly both.

 For all of these reasons, there is a pressing need for additional tools to help us
 differentiate heart failure from other causes of dyspnea in our acutely short of breath
 patients, and to improve our ability to provide accurate prognostic information and sound
 therapeutic management to our heart failure patients.
Inclusion Criteria:

 -  Eighteen years of age or older.

 -  The patients must be seen in the urgent care or emergency area with a chief complaint
 of shortness of breath not due to trauma.

 Exclusion Criteria:

 -  Patient is unable to sign or understand the consent form.

 -  Patient is on any dialysis.

 -  Patient has trauma related shortness of breath (i.e. penetrating wounds, crush
 injury).