Identifying Heart Failure When Minutes Count
The ambulance arrives: lights flashing, siren blaring. Paramedics rush their patient – a 55-year-old male complaining of severe shortness of breath – into the hospital’s emergency room. He may be a case of life-threatening heart failure, but many non-cardiac diseases have similar symptoms. Confirmation is critical. It will determine what happens next; how the patient will be treated.
For the last decade or so, in emergency rooms throughout the nation and world, doctors have come to rely upon a fast, simple blood test to measure a biomarker called B-type natriuretic peptide or BNP. If BNP levels in the blood are higher than normal, the heart is hurting and doctors can act accordingly.
Substantial credit for BNP goes to Alan S. Maisel, MD, a professor of medicine in the University of California, San Diego School of Medicine and director of the Coronary Care Unit and Heart Failure Program in the Veterans Affairs San Diego Healthcare System. It was Maisel, with colleagues, who helped develop and promote BNP in the late-1990s and early 2000s.
“In settings like emergency rooms, doctors need a quick, reliable way to determine what’s happened or happening to the heart,” said Maisel. “BNP does that.”
Heart failure (HF) does not mean the heart has stopped. Rather, it’s not pumping enough blood throughout the body. The leading causes of HF are coronary heart disease, high blood pressure and diabetes. An estimated 5 million Americans suffer from HF. It kills 30,000 annually.
Maisel continues to lead the HF fight. Like cancer, HF manifests itself differently in different people. It produces a host of tell-tale chemical signatures which may vary by individual. Maisel is conducting multiple research programs and trials, national and international, to not only refine the utility of BNP, but to develop new assays for other cardiac biomarkers, some of which can be detected less than an hour after a cardiac episode.
As part of that effort, he recently launched the Center for Biomarker Research at the UC San Diego Sulpizio Cardiovascular Center to attract more researchers and research here.
“The use of cardiac biomarkers has evolved,” Maisel said. “Blood tests like BNP started out as diagnostics. They gave us an idea of what had happened. Then we began to use them prognostically. They give us an idea of future heart failure risk, which helps doctors advise their patients. Now, we’re learning how to use these markers to actually guide treatment. Based on measurements, we can adjust medications to improve patients’ treatments and lives.”
Maisel, who is married to a nurse-practitioner at the San Diego VA and the father of five, is a whirlwind of activity, working in China to develop a BNP finger-stick test that can be done at home and jetting to Italy to establish a medical exchange with the University of Rome “La Sapienza.” He is co-founder of Cardero Therapeutics, a Sunnyvale biotech developing a drug based on a chocolate-derived flavenol shown to improve damaged mitochondrial in patients with advanced heart failure and type 2 diabetes.
In between, Maisel says he tries to do mini-triathlons (good for the heart), play tennis and work on his third novel. The first two – Bedside Manners and Brain Chicane – were medical thrillers, published in 2001 and 2003, respectively. He says he gave up sleep years ago.