What cancer marker is used to identify heart failure?

Cancer Markers Used to Identify Heart Failure

The primary cancer marker used to identify heart failure is not a cancer marker at all, but rather natriuretic peptides - specifically BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro-B-type natriuretic peptide). 1

Natriuretic Peptides as Cardiac Biomarkers

BNP and NT-proBNP are hormones released by the ventricles of the heart in response to pressure and volume overload. While they are not cancer markers, they are the gold standard biomarkers for:

• Confirming or ruling out the diagnosis of heart failure
• Risk stratification in heart failure patients
• Monitoring disease progression and response to therapy

Diagnostic Cut-offs for Heart Failure

• Acute setting (emergency department):

  • BNP: Values >100 pg/mL suggest heart failure (90% sensitivity, 76% specificity) 1
  • NT-proBNP: Values >450 pg/mL for patients <50 years and >900 pg/mL for patients ≥50 years 1

• Non-acute/ambulatory setting:

  • Lower cut-off values may be appropriate, but specific thresholds are less well-established 1

Confounding Factors Affecting Natriuretic Peptide Levels

Several factors can influence BNP and NT-proBNP levels:

• Factors that increase levels:

  • Advanced age
  • Renal dysfunction
  • Atrial fibrillation
  • Valvular heart disease
  • Right ventricular dysfunction

• Factors that decrease levels:

  • Obesity
  • Flash pulmonary edema (may not have sufficient time to rise)
  • Some stable but symptomatic chronic heart failure patients 1

Clinical Application Algorithm

1. Patient presents with symptoms suspicious for heart failure

   • Dyspnea, fatigue, edema, orthopnea

2. Measure BNP or NT-proBNP levels

   • Choose one biomarker and be consistent (they are not directly interchangeable)

3. Interpret results:

   • Very low levels (<100 pg/mL for BNP or age-appropriate cut-offs for NT-proBNP): Heart failure unlikely (>90% negative predictive value) 1
   • Elevated levels: Suggestive of heart failure but requires clinical correlation
   • Markedly elevated levels: High probability of heart failure

4. Clinical correlation:

   • Integrate biomarker results with clinical assessment and imaging (echocardiography)
   • Consider alternative causes of elevated natriuretic peptides

Important Caveats

• BNP and NT-proBNP are not cancer markers but cardiac biomarkers that reflect ventricular wall stress 1
• These biomarkers should not replace clinical judgment but rather complement it 1
• Routine testing is not recommended for patients with an obvious clinical diagnosis of heart failure 1
• These biomarkers cannot distinguish between systolic and diastolic heart failure 1
• Serial measurements may be more valuable than single measurements in some clinical scenarios 1

Other Emerging Biomarkers for Heart Failure

While not primary diagnostic tools, other biomarkers being studied include:

• Galectin-3 (for fibrosis and remodeling)
• Soluble ST2 receptor
• Growth differentiation factor-15 (GDF-15)
• Cardiac troponins (for risk stratification)
• MicroRNAs 1

None of these are cancer markers, but rather cardiac or inflammatory biomarkers that may provide additional information about heart failure pathophysiology and prognosis.

Clinical Pearls

• BNP and NT-proBNP have been incorporated into clinical trial entry criteria to identify patients with heart failure 1
• These biomarkers can effectively exclude heart failure except in the presence of obesity 1
• The FIND-HF acronym (Fatigue, Increased water accumulation, Natriuretic peptide testing, and Dyspnea) can help prompt consideration of heart failure diagnosis 2