Current Use of Cardiac Biomarkers in Various Heart Conditions

Prognostic Value of Endothelin-1 or Related Peptides in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

There is increasing evidence that endothelin-1 (ET-1) or related peptides play a prognostic value in coronary artery disease (CAD). The objective of this systematic review and meta-analysis was to evaluate the predictive role of ET-1 or related peptides in CAD patients. We comprehensively searched PubMed and Embase databases until January 15, 2023. Studies examining the association of ET-1, big ET-1, or C-terminal proendothelin-1 (CT-proET-1) level with all-cause mortality or major adverse cardiovascular events (MACEs) in CAD patients were included. Fourteen studies with 30,181 patients were identified. Comparison of the top and the lowest ET-1 level, the pooled risk ratio (RR) of all-cause mortality was 3.77 (95% confidence interval [CI] 1.59-8.94) for ET-1 and 1.65 (95% CI 1.25-2.18) for big ET-1. The pooled RR of MACEs was 2.24 (95% CI 1.85-2.72) for ET-1, 1.49 (95% CI 1.10-2.03) for big ET-1, and 3.55 (95% CI 2.12-5.96) for CT-proET-1, respectively. Subgroup analysis indicated that elevated ET-1 level was associated with 2.66-fold and 2.09-fold higher risk of in-hospital/30-day and long-term MACEs. Elevated ET-1, big ET-1, or CT-proET-1 may be independently associated with higher risk of all-cause mortality and MACEs in patients with CAD.

Influence of cardiac biomarkers on predicting significant coronary artery disease in hypertrophic cardiomyopathy patients

BACKGROUND

In this study, our aim was to investigate the role of cardiac biomarkers in predicting the presence of significant coronary artery disease in hypertrophic cardiomyopathy (HCM) patients.

METHODS

The study population was composed of hypertrophic cardiomyopathy patients who underwent coronary angiography at a single center between June 2021 and March 2023, and whose cardiac biomarkers were evaluated before the procedure. HCM patients were screened retrospectively. Significant CAD was defined as > 50% stenosis of the left main coronary artery or > 70% stenosis in a major coronary vessel. Demographic, echocardiographic and cardiac biomarker values were compared between the two groups.

RESULTS

A total of 123 patients were evaluated. Significant CAD was detected in 39 (31.7%) patients. Patients with significant CAD had higher CK-MB values than those without CAD [2.8 (2.1-4.0) vs. 3.4 (2.8-4.6), p = 0.036], and a higher level of high-sensitivity troponin T (hs-TnT) than those without CAD (24 vs. 17.8, p = 0.022). the NT-proBNP/hs-TnT ratio was found to be significantly lower in patients with CAD than in those with CAD (31.4 vs. 21.4, p = 0.019). In multivariate anaylsis, NT-proBNP/hs-TnT was determined as an independent predictor for significant CAD. In ROC analysis, NT-proBNP/hs-TnT ratio lower than the cut-off value of 30.7 could detect the presence of significant CAD with 76.9% sensitivity and 53.6% specificity (AUC: 0.632, 95% CI: 0.528-0.736, p = 0.019).

CONCLUSION

To sum up, we suggest that cardiac biomarkers were valuable and simple parameters in terms of significant CAD in HCM patients.

Developing a Preliminary Clinical Prediction Model for Prognosis of Pneumonia Complicated with Heart Failure Based on Metagenomic Sequencing

Background

The predictive factors of prognosis in patients with pneumonia complicated with heart failure (HF) have not been fully investigated yet, especially with the use of next-generation sequencing (NGS) of metagenome.

Methods

Patients diagnosed with pneumonia complicated with HF were collected and divided into control group and NGS group. Univariate and multivariate logistic regression and LASSO regression analysis were conducted to screen the predictive factors for the prognosis, followed by nomogram construction, ROC curve plot, and internal validation. Data analysis was conducted in SPSS and R software.

Results

The NGS of metagenome detected more microbial species. Univariate and multivariate logistic regression and LASSO regression analysis revealed that Enterococcus (χ² = 7.449, P = 0.006), Hb (Wals = 6.289, P = 0.012), and ProBNP (Wals = 4.037, P = 0.045) were screened out as potential predictive factors for the prognosis. Nomogram was constructed with these 3 parameters, and the performance of nomogram was checked in ROC curves (AUC = 0.772). The specificity and sensitivity of this model were calculated as 0.579 and 0.851, respectively, with the threshold of 0.630 in ROC curve. Further internal verification indicated that the predictive value of our constructed model was efficient.

Conclusion

This study developed a preliminary clinical prediction model for the prognosis of pneumonia complicated with HF based on NGS of metagenome. More objects will be collected and tested to improve the predictive model in the near future.

Identification of biomarkers for glycaemic deterioration in type 2 diabetes

We identify biomarkers for disease progression in three type 2 diabetes cohorts encompassing 2,973 individuals across three molecular classes, metabolites, lipids and proteins. Homocitrulline, isoleucine and 2-aminoadipic acid, eight triacylglycerol species, and lowered sphingomyelin 42:2;2 levels are predictive of faster progression towards insulin requirement. Of ~1,300 proteins examined in two cohorts, levels of GDF15/MIC-1, IL-18Ra, CRELD1, NogoR, FAS, and ENPP7 are associated with faster progression, whilst SMAC/DIABLO, SPOCK1 and HEMK2 predict lower progression rates. In an external replication, proteins and lipids are associated with diabetes incidence and prevalence. NogoR/RTN4R injection improved glucose tolerance in high fat-fed male mice but impaired it in male db/db mice. High NogoR levels led to islet cell apoptosis, and IL-18R antagonised inflammatory IL-18 signalling towards nuclear factor kappa-B in vitro. This comprehensive, multi-disciplinary approach thus identifies biomarkers with potential prognostic utility, provides evidence for possible disease mechanisms, and identifies potential therapeutic avenues to slow diabetes progression.

The proGnostic role of caRdiac rehAbilitation in patients with left ventriCular anEurysm formation after anterior myocardial infarction (the GRACE study): Study rationale and design of a prospective randomized controlled trial

Background

Cardiac rehabilitation (CR) is an essential intervention after acute myocardial infarction (MI). However, it is still unclear whether patients with left ventricular aneurysm (LVA) formation after anterior MI would benefit from CR programs. This clinical trial is designed to assess the role of CR in patients with LVA formation after anterior MI.

Trial design

The GRACE study is a single-center, single-blind, prospective, randomized controlled clinical trial in China. 100 subjects aged 18-75 years with LVA formation after anterior MI will be recruited and randomized 1:1 to the CR or control group. Both groups will receive standard drug treatment and routine health education according to the guidelines. Participants in the CR group will additionally receive tailored CR programs delivered over a period of 36 sessions. These participants will then be followed up for 1-year. The primary outcome is peak oxygen uptake measured by cardiopulmonary exercise testing after CR programs. The secondary outcomes are cardiac function and EuroQol 5-Dimension-3 Level index scores after CR program and 1-year and major adverse cardiac cerebrovascular events, a composite of cardiovascular mortality, non-fatal MI, non-fatal stroke, malignant arrhythmia or hospitalization for heart failure during the follow-up period.

Conclusions

This single-center, single-blind, prospective, randomized controlled clinical trial will determine whether CR improves physical capacity and clinical outcomes in patients with LVA formation after anterior MI.

Trial registration

Chinese Clinical Trial Registry ChiCTR2200058852. Registered on 18 April 2022.

Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study population were 150 consecutive patients treated for acute myocardial infarction. Results: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p=0,07), number of diseased vessels (p=0,027), and need for loop diuretic therapy (p=0,050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors. Keywords: myocardial infarction, cardiac biomarkers, cardiac troponin, natriuretic peptide, prognosis, major adverse cardiac events (MACE), cardiac death