Role of biomarkers in patients with dyspnea.

Background: The use of bio- markers has been demonstrated useful in many acute diseases both for diagnosis, prognosis and risk stratification. Objectives: The purpose of this review is to analyze several biomarkers of potential use in patients referring to Emergency Department with acute dyspnea. State of the Art: The role of natriuretic pep- tides has a proven utility in the diagnosis, risk stratification, patient management and prediction of outcome in acute and chronic heart failure (HF). New immunoassays are available for the detection of mid-region prohormones in patients with acute dyspnea such as Mid-region pro-adrenomedullin (MR-proADM) and Mid-region pro-atrial natriuretic peptide (MR-proANP). Also procalcitonin, copeptin and D-dimer, which are markers of inflammation, bacterial infections and sepsis, seem to be useful in the differential diagnosis of dyspnea. Conven- tional and high-sensitivity troponins are funda- mental, not only in the diagnosis of acute coronary syndromes, but also as indicators of mortality in patients with acute decompensated heart failure. Perspectives: Further studies with randomized controlled clinical trials will be needed to prove the theoretical clinical advantages offered by a shortness of breath biomarkers in terms of diag- nostic, prognostic, cost effective work-up and management of patients with acute dyspnea. Conclusions: A multimarker pannel approach performed by rapid and accurate assays could be useful for emergency physicians to promptly identify different causes of dyspnea thus man- aging to improve diagnosis, treatment and risk stratification.