<International Circulation>:The use of biomarkers in guiding heart failure therapy has seen advances. The biomarker-guided approach may have limited value in elderly patients， whereas it may reduce the risk of heart-failure hospitalization in younger patients who are already well managed pharmacologically by conventional standards. Do you agree with that statement?

 《国际循环》：近年来，生物标志物用于指导心力衰竭的临床治疗进展较多。但是，对于老年患者，生物标志物临床参考价值似乎受到一些限制，尽管其有益于降低已经接受正规药物治疗年轻患者的心力衰竭住院风险。您是否也这样认为？

    Dr Adams:  I think that as we go forward with biomarker guided therapy， we do need to explore the possibility that elderly patients may not benefit as much from this approach. One of the interesting things about biomarker guidance is that it is relatively low cost and it can be done without inconvenience to the patient. For instance， if you were going to start guiding an elderly patient and you were not able to increase medication and you were not able to change the biomarker， you can change the approach. Another important point is that the data that we have now is in patients who have reduced systolic function， that is patients with low ejection fraction. The problem for patients with preserved ejection fraction is we are not sure what to treat those patients with， so we don’t have good evidence-based medicine in the preserved EF population. I think it is going to be a lot harder for the biomarkers to help us because quite frankly we don’t know what treatment to guide. We do need more data， we do need larger trials and more robust trials even in the low EF and we need to explore the age issue more in these larger trials.

    Adams博士：我认为，在生物标志物指导治疗中，我们确实需要考虑到，老年患者可能不如年轻人一样受益。在生物标志物指导下的心衰治疗中，有趣的是，它的花费相对较低，而且不会给患者造成不便。例如，如果你要开始指导老年心衰患者的治疗，但不能够增加药物和改变测定的生物标志物，你可以换个方法。另一个重点是，我们现有的临床数据中是针对有收缩功能障碍，即低射血分数患者。对于射血分数正常的患者我们尚不能确定该如何进行治疗，所以我们对这部分患者没有遵循循证医学根据的用药指导。我认为要靠生物标志物来帮助我们，困难很大。即使是EF值降低的患者，我们也需要更多的数据，更大规模、更有力的临床试验来探索这个问题，在这些大型临时试验中，我们需要更多地考虑到年龄问题。