Novel insights in urinary and plasma biomarkers in heart failure

Johanna Elisabeth Emmens


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    Despite treatment advances in heart failure with reduced ejection fraction, its prognosis remains poor, and for patients with a preserved ejection fraction, there are no evidence-based treatment options available. This is likely related to the fact that heart failure constitutes a complex interplay among genetic, neurohormonal, inflammatory, and biochemical derangements, furthermore influenced by many comorbidities. In order to improve the treatment of heart failure, a better pathophysiological understanding of these derangements is warranted.
    Biomarkers may reflect parts of these processes underlying the pathophysiology of heart failure. First, this thesis showed that plasma measurement of kidney injury molecule-1, a renal tubular damage marker, is likely not a clinically applicable substitute for urinary measurements. Second, we showed that proenkephalin, a stable surrogate for endogenous opioid peptides enkephalins, might be a novel comprehensive renal marker in patients with heart failure. However, we also showed that proenkephalin is not suitable to identify individuals at risk of developing heart failure. In the next chapters we showed that worsening renal function in acute heart failure should be considered in the context of a patient’s diuretic response and that a parameter of renal proximal tubular function might be clinically relevant in heart failure. In a research letter we showed that plasma relaxin concentrations were not associated with parameters of right heart catheterization and echocardiographic parameters, and were therefore unable to replicate earlier published findings. Finally, we demonstrated the value of looking beyond static high-density lipoprotein cholesterol measurements in heart failure by studying its proteome composition and function.
    Originele taal-2English
    KwalificatieDoctor of Philosophy
    Toekennende instantie
    • Rijksuniversiteit Groningen
    • Voors, Adriaan, Supervisor
    • de Boer, Rudolf, Supervisor
    • ter Maaten, Jozine, Co-supervisor
    Datum van toekenning29-sep.-2021
    Plaats van publicatie[Groningen]
    Gedrukte ISBN's9789464167559
    StatusPublished - 2021


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