Editorial comment
Biomarkers in pulmonary hypertension: An ongoing quest for better outcomes
Biomarcadores na hipertensão pulmonar: uma busca contínua por melhores resultados
Maria Graça Castro
Serviço de Cardiologia, Hospitais da Universidade de Coimbra Centro, Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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"idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Biomarkers in pulmonary hypertension: An ongoing quest for better outcomes" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "128" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Maria Graça Castro" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Maria Graça" "apellidos" => "Castro" "email" => array:1 [ 0 => "castro2406@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospitais da Universidade de Coimbra Centro, Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Biomarcadores na hipertensão pulmonar: uma busca contínua por melhores resultados" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary hypertension (PH) is a rare disease that still carries a poor prognosis in spite of recent advances in management and the availability of new therapies. With current best practice, survival at one and five years is 90% and 65%, respectively.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Risk stratification plays a central role in disease management, guiding treatment strategies. At present it relies on a panel of indicators derived from clinical, exercise and hemodynamic evaluation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Although this assessment is of recognized value, it is complex and sometimes subjective and inaccurate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The development of new biomarkers has the potential to improve risk stratification. In order to be clinically useful, biomarkers must be reliable surrogates of meaningful clinical endpoints like mortality and must fully capture the net effect of treatment on clinical outcomes. Moreover, a valuable biomarker must be easy to measure and interpret, inexpensive, and provide independent information on prognosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In order to address this problem, various compounds have been studied in recent years and there is intense investigation of novel biomarkers.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Potential biomarkers for PH can generally be categorized based on their association with cardiac dysfunction, vascular and endothelial dysfunction, collagen metabolism, systemic inflammation and oxidative stress, and non-cardiopulmonary organ dysfunction.</p><p id="par0030" class="elsevierStylePara elsevierViewall">At present only two biomarkers, brain natriuretic peptide (BNP) and its N-terminal prohormone fragment (NT-proBNP), are recommended in clinical guidelines for risk stratification and follow-up in PH.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Plácido et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> analyze the role of novel biomarkers in PH and compare them to conventional NT-proBNP measurement and echocardiographic parameters. Based on their findings they propose a score that combines several biomarkers and has greater prognostic value than any of them separately.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This prospective observational study has the merit of analyzing several biomarkers in this population that have been more extensively studied in left heart failure.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Interestingly, the authors identify different temporal relationships between the biomarkers and the endpoints of mortality and death or hospitalization, suggesting that different pathogenic processes might play different roles according to disease states.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The findings of this study are in line with increasing evidence that a multiple biomarker approach could be superior to using only one biomarker.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although promising, the proposed multi-biomarker score needs further investigation and prospective validation in larger populations before it can be used in routine practice.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The development of valid new biomarkers will increase our knowledge of the basic pathologic mechanisms behind vascular pulmonary disease, as well as contributing to early diagnosis and differentiation of PH from other diseases and improving risk assessment before and during treatment. In the best scenario they might even help in individualizing prevention and treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Five-year outcomes of patients enrolled in the REVEAL Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.W. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 11 | 5 | 16 |
| 2024 Outubro | 40 | 36 | 76 |
| 2024 Setembro | 45 | 24 | 69 |
| 2024 Agosto | 44 | 30 | 74 |
| 2024 Julho | 36 | 28 | 64 |
| 2024 Junho | 33 | 17 | 50 |
| 2024 Maio | 46 | 27 | 73 |
| 2024 Abril | 37 | 25 | 62 |
| 2024 Maro | 33 | 25 | 58 |
| 2024 Fevereiro | 29 | 15 | 44 |
| 2024 Janeiro | 23 | 27 | 50 |
| 2023 Dezembro | 33 | 30 | 63 |
| 2023 Novembro | 41 | 28 | 69 |
| 2023 Outubro | 26 | 23 | 49 |
| 2023 Setembro | 24 | 13 | 37 |
| 2023 Agosto | 28 | 17 | 45 |
| 2023 Julho | 24 | 13 | 37 |
| 2023 Junho | 29 | 16 | 45 |
| 2023 Maio | 26 | 24 | 50 |
| 2023 Abril | 23 | 3 | 26 |
| 2023 Maro | 26 | 27 | 53 |
| 2023 Fevereiro | 23 | 25 | 48 |
| 2023 Janeiro | 23 | 28 | 51 |
| 2022 Dezembro | 27 | 19 | 46 |
| 2022 Novembro | 31 | 23 | 54 |
| 2022 Outubro | 31 | 23 | 54 |
| 2022 Setembro | 27 | 38 | 65 |
| 2022 Agosto | 35 | 38 | 73 |
| 2022 Julho | 24 | 30 | 54 |
| 2022 Junho | 21 | 22 | 43 |
| 2022 Maio | 23 | 25 | 48 |
| 2022 Abril | 20 | 25 | 45 |
| 2022 Maro | 27 | 35 | 62 |
| 2022 Fevereiro | 25 | 28 | 53 |
| 2022 Janeiro | 25 | 29 | 54 |
| 2021 Dezembro | 21 | 30 | 51 |
| 2021 Novembro | 25 | 40 | 65 |
| 2021 Outubro | 37 | 44 | 81 |
| 2021 Setembro | 21 | 25 | 46 |
| 2021 Agosto | 37 | 30 | 67 |
| 2021 Julho | 26 | 23 | 49 |
| 2021 Junho | 19 | 21 | 40 |
| 2021 Maio | 25 | 39 | 64 |
| 2021 Abril | 41 | 52 | 93 |
| 2021 Maro | 54 | 23 | 77 |
| 2021 Fevereiro | 46 | 17 | 63 |
| 2021 Janeiro | 40 | 8 | 48 |
| 2020 Dezembro | 31 | 10 | 41 |
| 2020 Novembro | 35 | 18 | 53 |
| 2020 Outubro | 30 | 13 | 43 |
| 2020 Setembro | 67 | 12 | 79 |
| 2020 Agosto | 21 | 5 | 26 |
| 2020 Julho | 44 | 8 | 52 |
| 2020 Junho | 38 | 19 | 57 |
| 2020 Maio | 47 | 20 | 67 |
| 2020 Abril | 30 | 14 | 44 |
| 2020 Maro | 45 | 15 | 60 |
| 2020 Fevereiro | 88 | 50 | 138 |
| 2020 Janeiro | 28 | 9 | 37 |
| 2019 Dezembro | 27 | 7 | 34 |
| 2019 Novembro | 38 | 11 | 49 |
| 2019 Outubro | 58 | 11 | 69 |
| 2019 Setembro | 12 | 8 | 20 |
| 2019 Agosto | 30 | 12 | 42 |
| 2019 Julho | 29 | 7 | 36 |
| 2019 Junho | 26 | 10 | 36 |
| 2019 Maio | 29 | 17 | 46 |
| 2019 Abril | 17 | 16 | 33 |
| 2019 Maro | 21 | 9 | 30 |
| 2019 Fevereiro | 41 | 8 | 49 |
| 2019 Janeiro | 17 | 7 | 24 |
| 2018 Dezembro | 24 | 12 | 36 |
| 2018 Novembro | 25 | 14 | 39 |
| 2018 Outubro | 59 | 24 | 83 |
| 2018 Setembro | 24 | 9 | 33 |
| 2018 Agosto | 29 | 13 | 42 |
| 2018 Julho | 13 | 6 | 19 |
| 2018 Junho | 37 | 7 | 44 |
| 2018 Maio | 45 | 8 | 53 |
| 2018 Abril | 53 | 4 | 57 |
| 2018 Maro | 68 | 8 | 76 |
| 2018 Fevereiro | 33 | 4 | 37 |
| 2018 Janeiro | 53 | 9 | 62 |
| 2017 Dezembro | 66 | 10 | 76 |
| 2017 Novembro | 57 | 8 | 65 |
| 2017 Outubro | 25 | 8 | 33 |
| 2017 Setembro | 30 | 12 | 42 |
| 2017 Agosto | 32 | 12 | 44 |
| 2017 Julho | 20 | 9 | 29 |
| 2017 Junho | 36 | 23 | 59 |
| 2017 Maio | 55 | 18 | 73 |
| 2017 Abril | 19 | 7 | 26 |
| 2017 Maro | 57 | 25 | 82 |
| 2017 Fevereiro | 86 | 75 | 161 |
| 2017 Janeiro | 0 | 2 | 2 |
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