Many tests allow physicians to evaluate the presence and severity of left ventricular dysfunction, but provide little information about its cause. Identification of the disorder leading to HF may be important because some causes of left ventricular dysfunction are reversible or treatable. However, it may not be possible to discern the cause of HF in many patients who present with this syndrome and in others, the underlying condition may not be amenable to treatment. Therefore, physicians should focus their efforts on diagnoses that have some potential for improvement, with therapy directed at the underlying condition.¹

Laboratory Tests

Clinical laboratory testing in the setting of heart failure focuses on two goals:⁵

• To explore possible underlying and potentially reversible causes of heart failure
• To estimate the degree of severity and risk of disease progression

Laboratory tests may reveal the presence of disorders or conditions that may lead to or exacerbate HF. The initial evaluation of patients with HF should include:^1,2

• A complete blood count (Hb, leukocytes, platelets)
• Urinalysis
• Serum electrolytes (including calcium and magnesium)
• Serum creatinine
• Blood lipids
• Tests for both renal and hepatic function
• Thyroid function tests
• Serum ferritin
• Transferrin saturation
• HIV screen
• High Sensitivity C-Reactive Protein
• Natriuretic Peptides (i.e., NT-proBNP or BNP)
• Myocardial specific enzyme analysis (i.e., Cardiac Troponin I) to exclude AMI in acute exacerbations
• Assays for connective tissue diseases*
• Assays for pheochromocytoma*

* If these diagnoses are suspected.

Clinical Assessment of Patients with Heart Failure
Identification of a Structural Abnormality
Evaluating the Cause of Ventricular Dysfunction
The Role of Natriuretic Peptides

References