National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Utilization of Biochemical Markers in Heart Failure: Preamble
The National Academy of Clinical Biochemistry’s (NACB) Laboratory Medicine Practice Guidelines (LMPG) for use of cardiac markers were published in July of 1999.1 The focus of this initial document was biomarkers of acute coronary syndromes; however, in the years since 1999, the natriuretic peptide B-type natriuretic peptide and its inert co-metabolite N-terminal proB-type natriuretic peptide have become available, and much knowledge has accumulated about their clinical utilization in the context of heart failure and hemodynamic stress. Because this increased knowledge has substantially expanded the scope of recommendations beyond myocardial necrosis, a NACB LMPG committee was formed to extend cardiac marker recommendations and establish modern guidelines for biochemical markers in heart failure. These extended recommendations include both clinical and analytical issues in the context of heart failure. During development, updated draft revisions of the guidelines were prepared and placed for comment on the NACB Web site (http://www.aacc.org/AACC/members/nacb/LMPG/OnlineGuide/DraftGuidelines/BioHearFailure/) in August of 2004. The draft LMPG and suggested revisions were presented for public and stakeholder comment at the October 2004 Arnold O. Beckman conference Cardiac Markers: Establishing Guidelines and Improving Results.
The guidance articles presented here represent the recommendations of the NACB for the rapidly evolving topics of clinical utilization of biochemical markers in heart failure and analytical issues for biochemical markers of heart failure. The latter of these documents represents a joint effort between the NACB and the International Federation of Clinical Chemistry’s Committee on Standardization of Markers of Cardiac Damage. Other sections of the cardiac marker guidelines involving clinical and analytical issues of acute coronary syndromes and other etiologies is available at http://www.aacc.org/ AACC/members/nacb/LMPG/OnlineGuide/PublishedGuidelines.
The strength of scientific data supporting each recommendation is characterized using the scoring criteria adopted from the American Heart Association/American College of Cardiology, as summarized in the Table. For each recommendation, the designations I, II, IIa, IIb, and III describe the indications, and the upper case letters A through C describe the weight of evidence.
These guidelines were developed utilizing best available evidence and incorporated substantial input from acknowledged experts and professional organizations. As such, they represent the current best practices for utilization of cardiac biomarkers in the context of heart failure.
This article has been copublished simultaneously online with the journal Clinical Biochemistryand at www.aacc.org.