scholarly journals Beyond the Limits: Clinical Utility of Novel Cardiac Biomarkers

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Radmilo Janković ◽  
Danica Marković ◽  
Nenad Savić ◽  
Vesna Dinić
Keyword(s):  
Clinical Studies ◽  
Statistical Significance ◽  
Preoperative Assessment ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
High Statistical Significance ◽  
Novel Biomarkers ◽  
Modern Medical Practice ◽  
New Research ◽  
Myocyte Damage

Preoperative assessment of cardiovascular risk is essential when it comes to extensive noncardiac surgery procedures. Therefore, accurate and timely diagnosis of myocyte damage is vital. In modern medical practice it is believed that the so-called “multimarker” approach is the most appropriate and most accurate, but new research points out that there are novel biomarkers which could be used independently. Studies that evaluate miRNA, H-FABP, and MR-PAMP give encouraging results. When it comes to miRNA clinical studies show high statistical significance, especially in the case of acute myocardial infarction (P=0.001). Statistical significance ofP=0.007was found in acute coronary syndrome, when H-FABP was measured. Biochemical marker MR-PAMP showed statistical significance ofP<0.0001in most clinical studies.

scholarly journals Novel Biomarkers in Cardiovascular Disease: A Review

2010 ◽  
Vol 2 (3) ◽  
pp. 66 ◽  
Author(s):  
Anna Meiliana ◽  
Andi Wijaya
Keyword(s):  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Medical Profession ◽  
Clinical Care ◽  
Disease Process ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Monitoring Tools ◽  
Novel Biomarkers ◽  
Protein Components

BACKGROUND: The investigation of novel circulating serum and plasma biomarkers in patients with cardiovascular disease has been accelerating at a remarkable pace. New markers or tests are often presented too early to the medical profession, potentially leading to overuse and, thus, extra burden and costs to patients, the healthcare industry, and the economy. The challenge for clinicians and medical researchers is how to optimally apply existing and new markers/tests.CONTENT: Biomarkers are biological parameters that can be objectively measured and quantified as indicators of normal biologic processes, pathogenic processes, or responses to a therapeutic intervention. Typically thought of as disease process screening, diagnosing, or monitoring tools, biomarkers may also be used to determine disease susceptibility and eligibility for specific therapies. Cardiac biomarkers are protein components of cell structures that are released into circulation when myocardial injury occurs. They play a pivotal role in the diagnosis, risk stratification, and treatment of patients with chest pain and suspected acute coronary syndrome (ACS) as well as those with acute exacerbations of heart failure.SUMMARY: Active investigation has brought forward an increasingly large number of novel candidate markers but few have withstood the test of time and become integrated into contemporary clinical care because of their readily apparent diagnostic, prognostic, and/or therapeutic utility. With regard to the more novel biomarkers, careful thought is needed with regard to the appropriate target populations for discovery and validation, as well as the criteria used to sort out the contenders from the pretenders.KEYWORDS: biomarker, cardiovascular disease, atherosclerosis, acute myocardial infarction, heart failure, risk stratification, diagnosis, prognosis

scholarly journals The role of the Advanced Clinical Practitioner (ACP) in triaging patients with Non ST-Elevation acute coronary syndromes (NSTE-ACS) patients for coronary angiographic procedures

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Comer
Keyword(s):  
Patient Outcomes ◽  
Patient Group ◽  
Statistical Significance ◽  
Economic Benefits ◽  
Cardiac Biomarkers ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
Hospital Transfer ◽  
Effective Transfer

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The introduction of the ACP role to a cardiology service with emphasis on measuring the effect of this role on improving the Inter-hospital transfer pathway for patients with ACS by improving patient outcomes ACPs triage a large number (estimated n = 2500 per year) of cardiology IHT referrals from these hospitals and ensure effective transfer to our centre for ACS treatment whilst supporting staff in the care of  those patients who do not meet our transfer criteria or are acutely unwell for transfer but cardiovascular stable Patients are listed in order of presenting symptoms, presence or absence of chest pain on admission, relevant blood results such as infection markers, kidney function, and troponin a cardiac biomarkers, ECG findings, drug history ,  past medical history and arrival to hospital rather than clinical urgency . Purpose Therefore the purpose of this evaluation was to measure the patient outcomes of introduction of an ACP in triaging patients with NSTE-ACS)patients for coronary angiographic procedures. Methods Quantitative design approach with a specialist cardiology setting using a 2-year observational analysis of the data.The study population included all patients referred for angioplasty or PCI via the Inter-hospital transfer acute coronary syndrome network including all patients referred for PCI following NSTE-ACS. Results : There were a total of n= 4976 patients referred for coronary angiogram +/-proceed procedures  between Feb 2018 and Feb 2020. Overall significant positive outcomes were noted across a consistent patient group based on presenting symptoms and patient characteristics when comparing data in the year preceding ACP led triage. A 2-sided p-value &lt;0.05 defined statistical significance and to reject the null hypothesis. There was a significant reduction in waiting time post introduction of ACP led triage (p &lt; 0.0001) equating to one day Comparison from pre ACP to post ACP led triage and clinical cancellation rates was reduced significantly (p = 0.0062). Rates of revascularisation were significantly higher post ACP led triage with a corresponding decrease in those managed medically (47.2% pre vs 43.1% post, p = 0.0037). These higher rates consisted of increased rates of both CABG (12.4% pre vs 13.5% post, p = 0.04) and PCI 40.4% vs 43.4%, p = 0.0216) Conclusion ACP led triage of ACS patients requiring urgent treatment demonstrates improved patient outcomes with economic benefits for healthcare providers, enhancing the service provided and opens up discussions for further quality improvement and implications to practice. Evidence of the benefits of advanced practice and the role of the advanced clinical practitioner is demonstrated within the cardiology setting and for the clinical triage of a patient group.

Cell Free and Exosomal Micro RNAs: Novel Biomarkers for Adverse Cardiac Remodelling and Heart Failure

2020 ◽  
Author(s):  
Alexander E Berezin
Keyword(s):  
Heart Failure ◽  
New Technologies ◽  
Coronary Intervention ◽  
Micro Rna ◽  
Cardiac Biomarkers ◽  
Cardiac Remodelling ◽  
Coronary Syndrome ◽  
Micro Rnas ◽  
Percutaneous Coronary ◽  
Novel Biomarkers

The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome / AMI and HF after AMI, and even fewer have been depicted the utility of biomarkers in AMI patients undergoing primary PCI. The aim of the review is focused an attention on non-coding cell-free and exosomal micro RNA as biomarkers of HF. Although there is a large number of evidence regarding predicative value of signature of miRNA in adverse cardiac remodelling and HF with different phenotypes, large clinical trials are required to be performed in the future to clearly elucidate whether miRNAs could be suitably for personalizing HF therapy.

scholarly journals Study of three novel biomarkers, MR-proADM, midkine, and stromelysin2, and peripheral atherosclerosis in a Chinese Han population: A case-control study

2020 ◽  
Vol 18 ◽  
pp. 205873922096055
Author(s):  
Zhong Chen ◽  
Yawen Zhu ◽  
Lili Zhang
Keyword(s):  
Regression Analysis ◽  
Protective Factor ◽  
Chinese Han Population ◽  
Cardiac Biomarkers ◽  
Chinese Han ◽  
Han Population ◽  
Coronary Syndrome ◽  
Cell Counts ◽  
Novel Biomarkers ◽  
Artery Disease

Midregional pro-adrenomedullin (MR-proADM), midkine, and stromelysin2 (ST2) are novel cardiac biomarkers associated with heart failure and atherosclerotic diseases like stable ischemic disease and acute coronary syndrome. The potential association between these three biomarkers and peripheral artery disease (PAD) remains unclear. The aim of this study was to assess the correlation between these three biomarkers and their association with PAD in the Chinese Han population. This study included 224 patients suspected of having coronary artery disease (CAD). All subjects underwent coronary angiography and carotid and subclavian ultrasound assessment for detection of coronary and peripheral atherosclerosis and were divided into two groups according to whether they had PAD or not. Pearson’s correlation coefficient r was calculated, and multivariable logistic regression analysis was conducted to represent the associations of these biomarkers and PAD. The study included 133 patients with PAD and 91 non-PAD controls and these two groups had similar values for age, ST2, hematocrit, hemoglobin, red blood cell counts, creatinine and CAD ratio, smoking, and type 2 diabetes (all p > 0.05). Compared with non-PAD controls, patients with PAD had lower levels of MR-proADM and midkine and higher levels of TC, LDL-C, and fasting blood sugar (FBS) (all p < 0.05). MR-proADM was positively and ST2 negatively correlated with midkine (all p < 0.05). Compared with females, male patients had higher values of MR-proADM ( p < 0.05) and similar levels of ST2 and midkine (all p > 0.05). Multivariable regression analysis identified FBS as a risk predictor (OR: 1.163, 95% CI: 1.108–1.401, p = 0.014) and MR-proADM as a protective factor (OR: 0.720, 95% CI: 0.529–0.920, p = 0.037) of PAD. Three novel biomarkers, MR-proADM, midkine, and ST2, are internally related, and MR-proADM is gender-specific and a protective factor of peripheral atherosclerosis in the Chinese Han population studied. Clinical Trial: ChiCTR-DDD-17013908

scholarly journals Acute coronary syndrome (STEMI, NSTEMI and unstable angina pectoris) and risk factors, similarities and differences

2020 ◽  
Vol 51 (4) ◽  
pp. 252-260
Author(s):  
Dalibor Mihajlović ◽  
Žana Maksimović ◽  
Boris Dojčinović ◽  
Nada Banjac
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Early Recognition ◽  
Statistical Significance ◽  
Unstable Angina Pectoris ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Banja Luka

Introduction: Acute coronary syndrome (ACS) is one of the m ost common and most dramatic manifestations of ischaemic h eart disease and distinguishing of ACS from non-cardiac chest pain represents a diagnostic challenge. Objective: Determine the frequency of ACS types: NSTEMI, STEMI and unstable angina pectoris (UAP) and examine the frequency and significance of risk factors and cardiospecific enzymes in patients with ACS. Methods: The analysis included patients who were referred from the prehospital level of the Banja Luka Primary Healthcare Centre (Emergency Department and Family Medicine Department) and treated under the ACS diagnosis in the coronary unit of the Cardiovascular Diseases Clinic of the Banja Luka University Clinical Centre of the Republic of Srpska (UCCRS) in the first 6 months of 2011. The study included patients older than 18, with recorded information on their gender, age, smoking status, hypertension, diabetes, obesity and family burden. Values of cholesterol, triglycerides, serum potassium, creatine kinase (CK), CK-MB, cardiac tro - ponin T (cTnT) were measured. Results: The total of 192 patients were referred under the referral diagnosis of ACS and treated in the coronary unit of the CVD Clinic of the Banja Luka UCCRS. At the same time, ACS was confirmed in 178 cases. STEMI was confirmed in 86 patients (48.31 %), NSTEMI in 55 (30.90 %) and UAP in 37 (20.79 %). ACS was statistically significantly more common in men (112 men and 66 women), in particular younger men (average age for men was 62.7 and 69.2 for men and women, respectively) (U = 2.472 x 103, p < 0.001). Among the risk factors, it was found th at smoking was more often associated with STEMI (p = 0.014) and hypertension with UAP (p = 0.041). Among all param eters, all three examined cardiac biomarkers showed statistical significance (p < 0.001), namely: values at STEMI > NSTEMI > UAP. Conclusion: Half of patients with ACS did not have STEMI (which is presumably easy to diagnose). Third of patients with ACS reported atypical symptoms, which further complicates the early recognition of MI without ST elevation. Precaution is needed in women and in elderly. Determination of cTnT should be available in every examination room.

Impact of copeptin, miRNA-499 and miRNA-208 as new biomarkers for early detection of acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S El-Deek ◽  
A.R Meki ◽  
A Hassan ◽  
M Gaber ◽  
O Mohamed
Keyword(s):  
Acute Coronary Syndrome ◽  
Early Detection ◽  
Sensitivity And Specificity ◽  
Cardiac Troponin ◽  
Roc Curve Analysis ◽  
Major Drawback ◽  
Expression Levels ◽  
Positive Correlation ◽  
Coronary Syndrome ◽  
Novel Biomarkers

Abstract Introduction Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide. Despite being the gold standard biomarkers, cTn and CK-MB have a major drawback as they are less sensitive in the first 3 hours of the onset of symptom. So, there is still a need for novel biomarkers, which can reliably rule in or rule out this disease immediately on admission. Aim of the work To evaluate the role of copeptin, miRNA-499 and miRNA-208 as novel biomarkers for early detection of unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) Patients and Methods: A total of 65 patients presenting within 4 h of onset of chest pain suggestive of ACS were enrolled in the study. They included 23 UA, 42 NSTEMI. Also 25 apparently healthy controls were included. Blood samples (first set within the first 3 hours and second set at 6 hours) were taken for estimation of copeptin by ELISA and miRNA-499 and miRNA-208 expression levels by real time PCR. Results Copeptin, miRNA-499 and miRNA-208 expression levels were significantly increased in UA and NSTEMI patients compared to controls (P&lt;0.001 each). Also these biomarkers were significantly increased in NSTEMT compared to UA (P&lt;0.001 each). They also significantly elevated in UA and NSTEMI patient in the first 3 hours who had negative cardiac troponin (p&lt;0.001 each). ROC curve analysis revealed that the area under curve (AUC) for prediction of ACS was 0.96 for copeptin, 0.97 for miRNA-499 and 0.0.97 for miRNA-208. Interestingly, combining copeptin with miRNA-499 and miRNA-210 significantly improved the diagnostic value by increasing the AUC to 0.98, P&lt;0.001. The sensitivity and specificity within the first 3 hours were 90%, 86% for copeptin, 95%, 94% for miRNA-499 and 93%, 98% for miRNA-208. The sensitivity and specificity were 81% and 86% for cardiac troponin within 6 hours. There was a positive correlation between copeptin and miRNA-499 and miRNA-208 (r=0.75, P&lt;0.001 and r=0.76, P&lt;0.001 respectively) Also, there was a positive correlation between these biomarkers and cTn (r=0.7. P&lt;0.001, r=0.64, P&lt;0.001 and r=0.68, P&lt;0.001 respectively). Conclusions Copeptin, miRNA-499 and miRNA-208 expression might be novel biomarkers as they are associated with UA and NSTEMI presented in the first 3 hours of onset of pain. The combination of copeptin and miRNA with cTn accelerate the diagnosis of ACS and avoiding the gray zone of cTn. Copeptin and miRNAs representing a potential aid in early diagnosis as they have different pathogenesis and site of liberation. Funding Acknowledgement Type of funding source: None

Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Ronny Alcalai ◽  
Boris Varshisky ◽  
Ahmad Marhig ◽  
David Leibowitz ◽  
Larissa Kogan-Boguslavsky ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Troponin I ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Cardiac Biomarkers ◽  
Fatty Acid Binding ◽  
Coronary Syndrome

<b><i>Background:</i></b> Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart<sup>©</sup>) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. <b><i>Methods:</i></b> We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. <b><i>Results:</i></b> Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, <i>p</i> = 0.002) whereas specificity was lower (78.6 vs. 95.4%, <i>p</i> = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, <i>p</i> = 0.08). <b><i>Conclusions:</i></b> Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

scholarly journals Sick euthyroid syndrome and its association with cardiogenic shock in acute coronary syndromes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Lobianco ◽  
D Costa ◽  
J.M Aladio ◽  
M Matsudo ◽  
S Swieszkowski ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Disease Severity ◽  
Statistical Significance ◽  
Cardiac Contractility ◽  
Categorical Variables ◽  
Severe Illness ◽  
Free T4 ◽  
Coronary Syndrome ◽  
Low T3 ◽  
Sick Euthyroid

Abstract Introduction Sick euthyroid syndrome (SES) constitutes an acute response to stress, and patients who develop it usually show more severe illness than those who do not. It could be related to disease severity in acute coronary syndrome (ACS), as assessed with Killip-Kimball class (KK), since cardiomyocytes are specifically sensitive to T3 levels. Objective To determine the prevalence of SES and low T3 in patients with ACS, and to assess its association with disease severity. Methods Prospective, observational and single center study in consecutive patients admitted to the CCU with a diagnosis of ACS. Clinical variables were collected from medical records; blood samples were obtained at admission to measure TSH, T3 and free T4 levels. SES was defined as low T3 with normal TSH and free T4. Maximum KK was determined by treating physicians. Categorical variables were compared with the chi-squared test, and categorical variables with Kruskal-Wallis and Wilcoxon tests. Statistical significance was set at p&lt;0.05. Results There were 149 patients with complete data available for analysis. Their age was 67.8±12.4 years, and 64% were male. A total of 16.3% had SES. There were 7.5% patients with SES and KK-A, 34.8% KK-B, 14.3% KK-C and 70% KK-D (p&lt;0.001). Thus, SES was more frequent in patients with some grade of heart failure, particularly cardiogenic shock. Figure 1 shows the difference in T3 values according to Killip-Kimball class. Conclusion Cardiomyocytes lack deiodinase and only possess T3 receptors, which makes them dependent on circulating T3 levels. T3 directly stimulates calcium channel and contractile protein synthesis in cardiomyocytes, and its deficit could affect cardiac contractility. Future studies should determine if thyroid hormone administration in cardiogenic shock can improve contractility and contribute to hemodynamic stability. T3 values according to Killip-Kimball Funding Acknowledgement Type of funding source: None

Abstract 12644: Growth Differentiation Factor-15 (GDF-15) for Risk Stratification in Patients After an Acute Coronary Syndrome: Insights From the SOLID-TIMI 52 trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eri Toda Kato ◽  
David A Morrow ◽  
Christopher P Cannon ◽  
Mary Ann Lukas ◽  
Andrzej Budaj ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Biomarkers ◽  
Individual Element ◽  
Clinical Predictors ◽  
Coronary Syndrome ◽  
Differentiation Factor ◽  
Increased Risk ◽  
Prognostic Utility ◽  
Traditional Risk Factors ◽  
Risk Predictors

Background: Growth differentiation factor (GDF)-15, a stress responsive cytokine, is associated with the risk of CV events after an acute coronary syndrome (ACS). Unlike other established cardiac biomarkers, the level of GDF-15 remains elevated in sub-acute phase after ACS and gradually decreases over time. We evaluated the prognostic utility of GDF-15 in patients after ACS accounting for established markers and risk predictors. Methods: GDF-15 (R&D Systems) and other established cardiac biomarkers (BNP, hsCRP and hsTnI) were measured at baseline in a randomly selected cohort of 4,968 patients enrolled within 30 days of hospitalization with ACS (median=14d) in SOLID-TIMI 52. Previously defined cutpoints were applied for GDF-15 concentration: <1200 (n=3451), 1200-1800 (n=919), and > 1800 ng/L (n=598). Analyses were adjusted for established risk predictors, days from the ACS event and other markers. MACE was defined as CV death, MI or stroke. Median follow-up was 2.5 years. Results: Patients with higher GDF-15 tended to be older, more likely to have diabetes, hypertension, history of revascularization, and CKD at baseline. Higher baseline levels of GDF-15 identified patients with higher rates of MACE as well as each individual element (p-trend <0.001 for all endpoints, Fig). The rate of MI was ∼2-fold higher in those with GDF-15 concentration >1800ng/L compared to patients with GDF-15 concentration <1200 ng/L. After adjustment for clinical predictors and other markers, GDF-15 was independently associated with the risk of MACE (HR 1.4, 95% CI 1.1-1.7; HR 1.8, 95% CI 1.4-2.3 for GDF-15 1200-1800, >1800, respectively). Individuals with GDF-15 >1800 ng/L had an increased risk of MI (adj HR 1.4, 95% CI 1.1-2.0) and stroke (adj HR 2.3, 95% CI 1.3-3.9). Conclusion: In patients after ACS, GDF-15 concentration is associated with the risk of MACE including MI and stroke independent of traditional risk factors and risk markers.

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