High-sensitive cardiac troponin T

Dynamic microphysiological system chip platform for high-throughput, customizable, and multi-dimensional drug screening

Spheroids and organoids have attracted significant attention as innovative models for disease modeling and drug screening. By employing diverse types of spheroids or organoids, it is feasible to establish microphysiological systems that enhance the precision of disease modeling and offer more dependable and comprehensive drug screening. High-throughput microphysiological systems that support optional, parallel testing of multiple drugs have promising applications in personalized medical treatment and drug research. However, establishing such a system is highly challenging and requires a multidisciplinary approach. This study introduces a dynamic Microphysiological System Chip Platform (MSCP) with multiple functional microstructures that encompass the mentioned advantages. We developed a high-throughput lung cancer spheroids model and an intestine-liver-heart-lung cancer microphysiological system for conducting parallel testing on four anti-lung cancer drugs, demonstrating the feasibility of the MSCP. This microphysiological system combines microscale and macroscale biomimetics to enable a comprehensive assessment of drug efficacy and side effects. Moreover, the microphysiological system enables evaluation of the real pharmacological effect of drug molecules reaching the target lesion after absorption by normal organs through fluid-based physiological communication. The MSCP could serves as a valuable platform for microphysiological system research, making significant contributions to disease modeling, drug development, and personalized medical treatment.

Circulating miRNA-21 as a diagnostic biomarker for acute coronary syndrome: a systematic review and meta-analysis of diagnostic test accuracy study

Background

Both early detection and treatment for acute coronary syndrome (ACS) have positively affected prognosis. A microRNA, miRNA-21 (miR-21), may have additional diagnostic potential for ACS among the others. This systematic review and meta-analysis aimed to evaluate the potential role of miR-21 in identifying ACS.

Methods

PubMed, EMBASE and CENTRAL databases were searched up to March 17, 2024, for case-control and cohort studies assessing the diagnostic value of circulating miR-21 in patients with ACS. The search was limited to studies published in either English or Chinese. The primary outcome was the discriminative ability to circulate miR-21 for ACS, represented by the area under the standard receiver operating characteristic curve (AUC) analysis. Meta-analyses combined the AUCs using a random-effects model. Heterogeneity among the studies was detected by the I2 and Q statistics. The quality of the studies included was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Publication bias analysis was assessed constructing by the Egger's test (PROSPERO: CRD42020209424).

Results

Eleven case-control studies containing a total of 2,413 subjects with 1,236 ACS cases and 1,177 controls were included. The mean age of participants in these studies ranges between 51.0 and 69.0 years. The meta-analysis showed an overall pooled AUC of 0.779 [95% confidence interval (CI): 0.715-0.843], with high heterogeneity noted between the studies (Q statistic =190.64, I2=94.23%, P<0.001). In subgroup analyses according to the subtypes of ACS, a pooled AUC of 0.767 (95% CI: 0.648-0.887) was derived from the studies focused on acute myocardial infarction cases only. The pooled AUC for unstable angina was 0.770 (95% CI: 0.718-0.822). In subgroup analyses according to the types of control groups, pooled AUC for ACS versus healthy controls was 0.779 (95% CI: 0.715-0.843), whereas the pooled AUC for ACS versus unhealthy controls was 0.740 (95% CI: 0.645-0.836). The quality assessment showed that the studies' overall quality was moderate. No evidence of publication bias was noted (P=0.49).

Conclusions

Circulating miR-21 shows abilities to differentiate between ACS and non-ACS, suggesting its potential as a novel diagnostic biomarker for ACS. However, the evidence is weakened by high heterogeneity observed among the studies. Further research is essential before it can be applied in clinical practice.

Low-intensity exercise training improves systolic function of heart during metastatic melanoma-induced cachexia in mice

Cardiac dysfunction frequently emerges in the initial stages of cancer cachexia, posing a significant complication of the disease. Physical fitness is commonly recommended in these early stages of cancer cachexia due to its beneficial impacts on various aspects of the condition, including cardiac dysfunction. However, the direct functional impacts of exercise on the heart during cancer cachexia largely remain unexplored. In this study, we induced cancer cachexia in mice using a metastatic B16F10 melanoma model. Concurrently, these mice underwent a low-intensity exercise regimen to investigate its potential role in cardiac function during cachexia. Our findings indicate that exercise training can help prevent metastatic melanoma-induced muscle loss without significant alterations to body and fat weight. Moreover, exercise improved the melanoma-induced decline in left ventricular ejection fraction and fractional shortening, while also mitigating the increase in high-sensitive cardiac troponin T levels caused by metastatic melanoma in mice. Transcriptome analysis revealed that exercise significantly reversed the transcriptional alterations in the heart induced by melanoma, which were primarily enriched in pathways related to heart contraction. These results suggest that exercise can improve systolic heart function and directly influence the transcriptome of the heart during metastatic melanoma-induced cachexia.

Highly selective optical sensor N/S-doped carbon quantum dots (CQDs) for the assessment of human chorionic gonadotropin β-hCG in the serum of breast and prostate cancer patients

A low-cost, accurate, and highly selective method was used for the assessment of the human chorionic gonadotropin β-hCG in the serum of breast and prostate cancer patients. This method is based on enhancing the intensity of luminescence displayed by the optical sensor N/S-doped carbon dots (CQDs) upon adding different concentrations of β-hCG. The luminescent optical sensor was synthesized and characterized through absorption and emission and is tailored to present blue luminescence at λem = 345 nm and λex = 288 nm at pH 7.8 in DMSO. The enhancement of the luminescence intensity of the N/S-doped CQDs, especially, the characteristic band at λem = 345 nm, is typically used for determining β-hCG in different serum samples. The dynamic range is 1.35-22.95 mU mL-1, and the limit of detection (LOD) and quantitation limit of detection (LOQ) are 0.235 and 0.670 mU mL-1, respectively. This method was practical, simple, and relatively free from interference effect. It was successfully applied to measure PCT in the samples of human serum, and from this method, we can assess some biomarkers of cancer-related diseases in human body.

Modern View on the Role of Sex-Specific Levels of High-Sensitive Cardiospecific Troponins T and I in the Diagnosis of Myocardial Infarction

It is well known that the molecules of cardiospecific troponins T and I are localized in the troponin-tropomyosin complex of the cytoplasm of cardiac myocytes and, due to the specific localization, these cardiospecific troponins are widely used as diagnostic biomarkers of myocardial infarction. Cardiospecific troponins are released from the cytoplasm of cardiac myocytes as a result of irreversible cell damage (for example, ischemic necrosis of cardiomyocytes in myocardial infarction or apoptosis of cardiac myocytes in cardiomyopathies and heart failure) or reversible damage (for example, intense physical exertion, hypertension, the influence of stress factors, etc.). Current immunochemical methods for determining cardiospecific troponins T and I have extremely high sensitivity to subclinical (minor) damage to myocardial cells and, thanks to modern high-sensitive methods, it is possible to detect damage to cardiac myocytes in the early (subclinical) stages of a number of cardiovascular pathologies, including myocardial infarction. So, recently, leading cardiological communities (the European Society of Cardiology, the American Heart Association, the American College of Cardiology, etc.) have approved algorithms for early diagnosis of myocardial infarction based on the assessment of serum levels of cardiospecific troponins in the first 1 - 3 h after the onset of pain syndrome. An important factor that may affect early diagnostic algorithms of myocardial infarction are sex-specific features of serum levels of cardiospecific troponins T and I. This manuscript presents a modern view on the role of sex-specific serum levels of cardiospecific troponins T and I in the diagnosis of myocardial infarction and the mechanisms of formation of sex-specific serum levels of troponins.

Correlation of rheumatoid and cardiac biomarkers with cardiac anatomy and function in rheumatoid arthritis patients without clinically overt cardiovascular diseases: A cross-sectional study

Background

Cardiac biomarkers have been shown to be related to cardiac abnormalities; nonetheless, few studies have confirmed the association between cardiac and rheumatoid biomarkers in rheumatoid arthritis (RA) patients. This study assessed the correlation of rheumatoid and cardiac biomarker levels with cardiac anatomy and function and explored the interaction between cardiac and rheumatoid biomarkers in RA patients without clinically overt cardiovascular diseases.

Methods

A cross-sectional study was conducted among RA patients aged 18-65 years without other connective tissue diseases, overlap syndrome, heart disease, or renal failure were included. Main cardiac and rheumatoid biomarkers, including high-sensitivity troponin T (hsTropT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), rheumatoid factor, and anti-cyclic citrullinated peptide antibody (ACPA), were collected. Echocardiography was performed to examine cardiac anatomy and function.

Results

The mean left ventricular mass index (LVMI) was 80.8 g/sqm, and the relative wall thickness was 0.4. The mean left ventricular ejection fraction was 70.3%. The hsTropT levels showed a weak positive correlation with LVMI and E/e' ratio and a very weak correlation with E/A ratio. Interaction effect between hsTropT and ACPA on LVMI was found in univariate analysis, not in multivariate analysis. Higher systolic blood pressure (SBP) and the use of non-steroidal anti-inflammatory drug (NSAID) increased the LVMI. Only age was related to the E/e' increase.

Conclusion

The effect of hsTropT on LVMI was probably modified by ACPA in RA patients without clinically overt cardiovascular diseases. Age, SBP, and NSAID use among RA patients should be taken into account due to their relations to cardiac abnormalities.

Mid-term subclinical myocardial injury detection in patients who recovered from COVID-19 according to pulmonary lesion severity

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) may cause damage to the cardiovascular system during the acute phase of the infection. However, recent studies reported mid- to long-term subtle cardiac injuries after recovering from acute coronavirus disease 2019 (COVID-19). This study aimed to determine the relationship between the severity of chest computed tomography (CT) lesions and the persistence of subtle myocardial injuries at mid-term follow-up of patients who recovered from COVID-19 infection.

Methods

All patients with COVID-19 were enrolled prospectively in this study. Sensitive troponin T (hsTnT) and chest CT scans were performed on all patients during the acute phase of COVID-19 infection. At the mid-term follow-up, conventional transthoracic echocardiograph and global longitudinal strain (GLS) of the left and right ventricles (LV and RV) were determined and compared between patients with chest CT scan lesions of &lt; 50% (Group 1) and those with severe chest CT scan lesions of greater or equal to 50% (Group 2).

Results

The mean age was 55 ± 14 years. Both LV GLS and RV GLS values were significantly decreased in group 2 (p = 0.013 and p = 0.011, respectively). LV GLS value of more than −18 was noted in 43% of all the patients, and an RV GLS value of more than −20 was observed in 48% of them. The group with severe chest CT scan lesions included more patients with reduced LV GLS and reduced RV GLS than the group with mild chest CT scan lesions [(G1:29 vs. G2:57%, p = 0.002) and (G1:36 vs. G2:60 %, p = 0.009), respectively].

Conclusion

Patients with severe chest CT scan lesions are more likely to develop subclinical myocardial damage. Transthoracic echocardiography (TTE) could be recommended in patients recovering from COVID-19 to detect subtle LV and RV lesions.

Overcoming the cardiac toxicities of cancer therapy immune checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) have led recent advances in the field of cancer immunotherapy improving overall survival in multiple malignancies with abysmal prognoses prior to their introduction. The remarkable efficacy of ICIs is however limited by their potential for systemic and organ specific immune-related adverse events (irAEs), most of which present with mild to moderate symptoms that can resolve spontaneously, with discontinuation of therapy or glucocorticoid therapy. Cardiac irAEs however are potentially fatal. The understanding of autoimmune cardiotoxicity remains limited due to its rareness. In this paper, we provide an updated review of the literature on the pathologic mechanisms, diagnosis, and management of autoimmune cardiotoxicity resulting from ICIs and their combinations and provide perspective on potential strategies and ongoing research developments to prevent and mitigate their occurrence.

Cardiac MRI findings in patients with Crohn's disease

BACKGROUND

Early cardiac death is more common in patients with Crohn's disease (CD) than in healthy adults, but the exact cause is unknown.

AIMS

The aim of this study is to investigate the cardiac magnetic resonance imaging (MRI) findings in patients with CD and compare the MRI findings with healthy controls (HCs). This study also aimed to demonstrate the possible cardiac involvement in patients with CD using MRI.

METHODS

In this prospective study, participants with CD (n = 20) and HC (n = 20) underwent cardiac MRI. Erythrocyte sedimentation rate (ESR) and hematocrit levels were investigated before MRI in both groups. Two observers evaluated the ventricular functional and morphological parameters in consensus. Myocardial T1/T2-relaxation times were calculated by two observers independently using two different software, and hematocrit-corrected left ventricle extracellular volume (LV-ECV) was calculated. Observer-2 also performed histogram analysis for T1/T2-mapping images.

RESULTS

Patients with CD had a significantly higher LV-ECV, mildly decreased right ventricle ejection fraction, and prolonged T2-relaxation time than HC. Moreover, histogram analysis showed that the maximum and mean T2-relaxation times were higher in patients with CD. There was an excellent agreement between observers for the assessment of mean native and post-contrast T1-relaxation time (intraclass correlation coefficient (ICC) of 0.991 and ICC of 0.941, respectively) and mean T2-relaxation time measurements (ICC of 0.983). Moreover, mean T2-relaxation time was found to be significantly correlated with ESR.

CONCLUSIONS

This study suggests visually undetectable myocardial involvement due to chronic systemic inflammation in patients with Crohn's disease. Cardiac MRI can help assess and monitor cardiac involvement in patients with CD.

Prevalence and clinical association of the presence of anti-neutrophilic cytoplasmic antibody in systemic sclerosis

INTRODUCTION

Anti-neutrophilic cytoplasmic antibody (ANCA) has been reported in systemic sclerosis (SSc). Some clinical features of SSc can also be presented with ANCA-associated vasculitis. Objectives were to determine the prevalence and clinical associations with ANCA among Thais with SSc.

MATERIAL AND METHODS

A cross-sectional study of Thai adult SSc patients was conducted. According to the sample size calculation, 185 patients were included. Clinical and laboratory tests for serology and others for evaluation of the clinical association with ANCA were done simultaneously on the study date.

RESULTS

The female to male ratio was 2 : 1. The majority had the diffuse SSc subset (71.2%). The respective prevalence of having a) at least 1 serological test for ANCA (viz., perinuclear ANCA, cytoplasmic ANCA, anti-myeloperoxidase, or anti-proteinase3), b) positive for either p-ANCA or c-ANCA, c) positive for either anti-MPO or anti-PR3, d) p-ANCA and anti-MPO and e) c-ANCA and anti-PR3 was 21.6% (95% CI: 15.9-28.3), 11.9% (95% CI: 7.6-17.4) and 13.0% (95% CI: 8.5-18.7) and 1% (95% CI: 0.1-3.9). By multivariate analysis, the erythrocyte sedimentation rate elevation was significantly associated with the presence of the antibody (OR = 11.36, 95% CI: 1.44-83.65), while elevation of high sensitivity cardiac troponin-T (hs-cTnT) was significantly associated with the presence of either p-ANCA or c-ANCA (OR = 4.25, 95% CI: 1.41-15.34). None of the patients had clinical features of systemic vasculitis.

CONCLUSIONS

Around one-fifth of SSc patients have detectible ANCA without any features of vasculitis. The presence of ANCA is associated with inflammation and myocardial injury. ANCA is not antibody specific for vasculitis in SSc.

From Prevention to Disease Perturbations: A Multi-Omic Assessment of Exercise and Myocardial Infarctions

While a molecular assessment of the perturbations and injury arising from diseases is essential in their diagnosis and treatment, understanding changes due to preventative strategies is also imperative. Currently, complex diseases such as cardiovascular disease (CVD), the leading cause of death worldwide, suffer from a limited understanding of how the molecular mechanisms taking place following preventive measures (e.g., exercise) differ from changes occurring due to the injuries caused from the disease (e.g., myocardial infarction (MI)). Therefore, this manuscript assesses lipidomic changes before and one hour after exercise treadmill testing (ETT) and before and one hour after a planned myocardial infarction (PMI) in two separate patient cohorts. Strikingly, unique lipidomic perturbations were observed for these events, as could be expected from their vastly different stresses on the body. The lipidomic results were then combined with previously published metabolomic characterizations of the same patients. This integration provides complementary insights into the exercise and PMI events, thereby giving a more holistic understanding of the molecular changes associated with each.

Troponin Levels at Presentation Before Coronary Angiogram and Their Association With Cost, Mortality, and Readmission

Background and objective

In patients undergoing coronary angiogram, the degree of cardiac enzyme elevation at presentation has been thought of as a strong and independent predictor of in-hospital mortality and readmission. Recent studies, however, have suggested a lack of clarity regarding this speculation, particularly with regard to troponin elevations. Additionally, the impact of troponin levels (TnI) at presentations on cost is poorly understood. In this study, we aimed to evaluate the association of Tnl at initial presentation with 30-day all-cause readmission and all-cause mortality as well as admission costs.

Methods

This study was a retrospective analysis of 7,388 patients who underwent coronary angiogram at our facility from 2015 to 2017. Patients were identified from a local CathPCI Registry^® registry, and a subsequent chart review was performed for readmission and mortality data. Cost data were provided by our in-facility finance department. We excluded patients with incomplete records and those who required coronary artery bypass grafting (CABG). After the exclusion of patients deemed ineligible, the final sample size eligible for analysis was 1,163. Patients were divided into two groups based on Tnl at presentation with a cut-off value of 0.04 ng/ml. Adjusted regression and multivariate analysis were used for clinical outcomes. Primary outcomes were 30-day readmission and mortality. The secondary outcome was the admission cost.

Results

Within our cohort, the average participant age was 64.6 years (SD: 12.7), and the majority of them were male (70.7%). Of these patients, 207 had lower TnI (<0.04 ng/ml), while 956 had higher TnI at presentation. The high TnI (≥0.04 ng/ml) group had a significantly higher number of patients with a family history of coronary artery disease (CAD) (13.8% vs. 7.7%: p=0.017) and those on dialysis (3.2% vs. 0.5%: p=0.028) compared to the low Tnl group. Additionally, we did not find any significant difference in 30-day mortality or readmission between the two groups in our cohort. On average, each patient in the high TnI group spent $936 more for hospital admissions compared to patients in the low Tnl group. However, this difference was not statistically significant.

Conclusions

Tnl at admission did not reveal a significant impact on 30-day mortality or readmission, which is consistent with the findings of previous studies. A high Tnl at admission increased the cost of admission; however, the difference was not statistically significant in our cohort.

COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells following binding with the cell surface ACE2 receptors, thereby leading to coronavirus disease 2019 (COVID-19). SARS-CoV-2 causes viral pneumonia with additional extrapulmonary manifestations and major complications, including acute myocardial injury, arrhythmia, and shock mainly in elderly patients. Furthermore, patients with existing cardiovascular comorbidities, such as hypertension and coronary heart disease, have a worse clinical outcome following contraction of the viral illness. A striking feature of COVID-19 pandemics is the high incidence of fatalities in advanced aged patients: this might be due to the prevalence of frailty and cardiovascular disease increase with age due to endothelial dysfunction and loss of endogenous cardioprotective mechanisms. Although experimental evidence on this topic is still at its infancy, the aim of this position paper is to hypothesize and discuss more suggestive cellular and molecular mechanisms whereby SARS-CoV-2 may lead to detrimental consequences to the cardiovascular system. We will focus on aging, cytokine storm, NLRP3/inflammasome, hypoxemia, and air pollution, which is an emerging cardiovascular risk factor associated with rapid urbanization and globalization. We will finally discuss the impact of clinically available CV drugs on the clinical course of COVID-19 patients. Understanding the role played by SARS-CoV2 on the CV system is indeed mandatory to get further insights into COVID-19 pathogenesis and to design a therapeutic strategy of cardio-protection for frail patients.

Early Elevation of Systemic Plasma Clusterin after Reperfused Acute Myocardial Infarction in a Preclinical Porcine Model of Ischemic Heart Disease

Clusterin exerts anti-inflammatory, cytoprotective and anti-apoptotic effects. Both an increase and decrease of clusterin in acute myocardial infarction (AMI) has been reported. We aimed to clarify the role of clusterin as a systemic biomarker in AMI. AMI was induced by percutaneous left anterior artery (LAD) occlusion for 90 min followed by reperfusion in 24 pigs. Contrast ventriculography was performed after reperfusion to assess left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) and additional cMRI + late enhancement to measure infarct size and LV functions at day 3 and week 6 post-MI. Blood samples were collected at prespecified timepoints. Plasma clusterin and other biomarkers (cTnT, NT-proBNP, neprilysin, NGAL, ET-1, osteopontin, miR21, miR29) were measured by ELISA and qPCR. Gene expression profiles of infarcted and remote region 3 h (n = 5) and 3 days (n = 5) after AMI onset were analysed by RNA-sequencing. AMI led to an increase in LVEDV and LVESV during 6-week, with concomitant elevation of NT-proBNP 3-weeks after AMI. Plasma clusterin levels were increased immediately after AMI and returned to normal levels until 3-weeks. Plasma NGAL, ET-1 and miR29 was significantly elevated at 3 weeks follow-up, miR21 increased after reperfusion and at 3 weeks post-AMI, while circulating neprilysin levels did not change. Elevated plasma clusterin levels 120 min after AMI onset suggest that clusterin might be an additional early biomarker of myocardial ischemia.

Cellular and Molecular Differences between HFpEF and HFrEF: A Step Ahead in an Improved Pathological Understanding

Heart failure (HF) is the most rapidly growing cardiovascular health burden worldwide. HF can be classified into three groups based on the percentage of the ejection fraction (EF): heart failure with reduced EF (HFrEF), heart failure with mid-range-also called mildly reduced EF- (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). HFmrEF can progress into either HFrEF or HFpEF, but its phenotype is dominated by coronary artery disease, as in HFrEF. HFrEF and HFpEF present with differences in both the development and progression of the disease secondary to changes at the cellular and molecular level. While recent medical advances have resulted in efficient and specific treatments for HFrEF, these treatments lack efficacy for HFpEF management. These differential response rates, coupled to increasing rates of HF, highlight the significant need to understand the unique pathogenesis of HFrEF and HFpEF. In this review, we summarize the differences in pathological development of HFrEF and HFpEF, focussing on disease-specific aspects of inflammation and endothelial function, cardiomyocyte hypertrophy and death, alterations in the giant spring titin, and fibrosis. We highlight the areas of difference between the two diseases with the aim of guiding research efforts for novel therapeutics in HFrEF and HFpEF.

The effects of gasotransmitters inhibition on biochemical and haematological parameters and oxidative stress in propofol-anaesthetized Wistar male rats

This study aimed to investigate the effects of propofol through evaluating its interaction with nitric oxide (NO), hydrogen sulfide (H2S), and carbon monoxide (CO). Wistar male rats were divided in 4 groups: (1) bolus injection of propofol (1% 10 mg/mL, 100 mg/kg bw, i.p.); (2) Nω-nitro-l-arginine methyl ester (L-NAME; NO synthase inhibitor, 60 mg/kg bw, i.p.) + bolus injection of propofol (1% 10 mg/mL, 100 mg/kg bw, i.p.); (3) DL-propargylglycine (DL-PAG; H2S synthase inhibitor, 50 mg/kg bw, i.p.) + bolus injection of propofol (1% 10 mg/mL, 100 mg/kg bw, i.p.); (4) zinc protoporphyrin IX (ZnPPIX; CO synthase inhibitor, 50 μmol/kg bw, i.p.) + bolus injection of propofol (1% 10 mg/mL, 100 mg/kg bw, i.p.). Increased levels of albumins, low-density lipoproteins, alkaline phosphatase, amylase, high-sensitivity Troponin T, and fibrinogen were found in L-NAME + propofol group. Platelet crit, platelet count, total cholesterol, and high-density lipoproteins were elevated in ZnPPIX + propofol group. Hydrogen peroxide was increased in all groups treated with gasotransmitters inhibitors. Reduced glutathione was reduced in all groups, superoxide dismutase activity only in L-NAME + propofol. The effect of propofol on various biochemical, haematological, and oxidative stress markers may be at least in part mediated through interaction with 3 estimated gasotransmitters.

Subclinical Cardiovascular Disease and Fall Risk in Older Adults: Results From the Atherosclerosis Risk in Communities Study

BACKGROUND/OBJECTIVES

Falls are frequent and often devastating events among older adults. Cardiovascular disease (CVD) is associated with greater fall risk; however, it is unknown if pathways that contribute to CVD, such as subclinical myocardial damage or wall strain, are related to future falls. We hypothesized that elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), measured in older adults, would be associated with greater fall risk.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke.

MEASUREMENTS

We measured hs-cTnT or NT-proBNP in 2011 to 2013. Falls were identified from hospital discharge International Classification of Diseases, Ninth Revision (ICD-9), codes or Centers for Medicare and Medicaid Services claims. We used Poisson models adjusted for age, sex, and race/study center to quantify fall rates across approximate quartiles of hs-cTnT (less than 8, 8-10, 11-16, and 17 or greater ng/L) and NT-proBNP (less than 75, 75-124, 125-274, and 275 or greater pg/mL). We used Cox models to determine the association of cardiac markers with fall risk, adjusted for age, sex, race/center, and multiple fall risk factors.

RESULTS

Among 3973 participants (mean age = 76 ± 5 years, 62% women, 22% black), 457 had a subsequent fall during a median follow-up of 4.5 years. Incidence rates across quartiles of hs-cTnT and NT-proBNP were 17.1, 20.0, 26.2, and 36.4 per 1000 person-years and 12.8, 22.2, 28.7, and 48.4 per 1000 person-years, respectively. Comparing highest vs lowest quartiles of either hs-cTnT or NT-proBNP demonstrated a greater than two-fold higher fall risk, with hazard ratios of 2.17 (95% confidence interval {CI} = 1.60-2.95) and 2.34 (95% CI = 1.73-3.16), respectively. In a joint model, the relationships of hs-cTnT and NT-proBNP with falls were significant and independent.

CONCLUSION

Subclinical elevations of cardiac damage and wall strain were each associated with a higher fall risk in older adults. Further research is needed to determine whether interventions that lower hs-cTnT or NT-proBNP also lower fall risk. J Am Geriatr Soc 67:1795-1802, 2019.

MicroRNAs in acute myocardial infarction: Evident value as novel biomarkers?

Traditional circulating biomarkers play a fundamental role in the diagnosis and prognosis of acute myocardial infarction (AMI). However, they have several limitations. microRNAs (miRs), a class of RNA molecules that do not encode proteins, function directly at the RNA level by inhibiting the translation of messenger RNAs. Due to their significant roles in disease development, they can be used as biomarkers. Accumulating evidence has revealed an attractive role of miRs as biomarkers of AMI and its associated symptoms, including vulnerable atherosclerotic plaques, and their role in disease diagnosis, platelet activation monitoring, and prognostic outcome prediction. This manuscript will highlight the recent updates regarding the involvement of miRs as biomarkers in AMI and emphasize their value in vulnerable atherosclerotic plaque prediction and monitoring of platelet activation.

Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective

Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.

Elevated plasma S100A1 level is a risk factor for ST-segment elevation myocardial infarction and associated with post-infarction cardiac function

AIM

To investigate the association between plasma S100A1 level and ST-segment elevation myocardial infarction (STEMI) and potential significance of S100A1 in post-infarction cardiac function.

METHODS

We examined the plasma S100A1 level in 207 STEMI patients (STEMI group) and 217 clinically healthy subjects for routine physical examination without a history of coronary artery disease (Control group). Baseline characteristics and concentrations of relevant biomarkers were compared. The relationship between S100A1 and other plasma biomarkers was detected using correlation analysis. The predictive role of S100A1 on occurrence of STEMI was then assessed using multivariate ordinal regression model analysis after adjusting for other covariates.

RESULTS

The plasma S100A1 level was found to be significantly higher (P<0.001) in STEMI group (3197.7±1576.0 pg/mL) than in Control (1423.5±1315.5 pg/mL) group. Furthermore, the correlation analysis demonstrated plasma S100A1 level was significantly associated correlated with hypersensitive cardiac troponin T (hs-cTnT) (r = 0.32; P < 0.001), creatine kinase MB (CK-MB) (r = 0.42, P < 0.001), left ventricular eject fraction (LVEF) (r = -0.12, P = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (r = 0.61; P < 0.001) and hypersensitive C reactive protein (hs-CRP) (r = 0.38; P < 0.001). Moreover, the enrolled subjects who with a S100A1 concentration ≤ 1965.9 pg/mL presented significantly better cardiac function than the rest population. Multivariate Logistic regression analysis revealed that S100A1 was an independent predictor for STEMI patients (OR: 0.671, 95% CI 0.500-0.891, P<0.001). In addition, higher S100A1 concentration (> 1965.9 pg/mL) significantly increased the risk of STEMI as compared with the lower level (OR: 6.925; 95% CI: 4.15-11.375; P<0.001).

CONCLUSION

These results indicated that the elevated plasma S100A1 level is an important predictor of STEMI in combination with several biomarkers and also potentially reflects the cardiac function following the acute coronary ischemia.

Prognostic value of homocysteine and highly sensitive cardiac troponin T in children with acute heart failure

OBJECTIVE

Heart failure (HF) is a progressive disorder in children. Many HF biomarkers have been identified to assess its severity and predict its course. The aim of this study was to evaluate the prognostic value of plasma levels of homocysteine (HCY) and highly sensitive cardiac troponin T (hs-cTnT) in children with HF.

MATERIALS AND METHODS

Eighty children with acute HF were enrolled in this study as the patient group and 80 healthy children of matched age and sex served as the control group. HCY and hs-cTnT serum levels were measured before and after HF treatment; additionally, echocardiographic examinations were performed before and after therapy. All patients were followed up for 3 months.

RESULTS

Plasma levels of HCY and hs-cTnT were significantly higher in children with HF before treatment, compared with their levels in children with HF after treatment and with the control group. This increase in serum levels of both biomarkers was associated with increased severity of HF according to the Ross classification of HF. HCY had higher specificity, positive predictive value, and accuracy than hs-cTnT. Serum levels of both biomarkers had a significant positive correlation with cardiomegaly and a significant negative correlation with left ventricular ejection fraction and fraction shortening. Marked elevation of both serum biomarkers was significantly associated with poor outcome with mortality rate of 10%.

CONCLUSION

Plasma HCY and serum hs-cTnT levels have a good prognostic value in children with congestive heart failure (CHF) and their levels significantly correlated with clinical and echocardiographic data, severity of HF, and adverse outcome in children with CHF.

A portable prototype magnetometer to differentiate ischemic and non-ischemic heart disease in patients with chest pain

BACKGROUND

Magnetocardiography (MCG) is a non-invasive technique used to measure and map cardiac magnetic fields. We describe the predictive performance of a portable prototype magnetometer designed for use in acute and routine clinical settings. We assessed the predictive ability of the measurements derived from the magnetometer for the ruling-out of healthy subjects and patients whose chest pain has a non-ischemic origin from those with ischemic heart disease (IHD).

METHODS

MCG data were analyzed from a technical performance study, a pilot clinical study, and a young healthy reference group. Participants were grouped to enable differentiation of those with IHD versus non-IHD versus controls: Group A (70 IHD patients); Group B (69 controls); Group C (37 young healthy volunteers). Scans were recorded in an unshielded room. Between-group differences were explored using analysis of variance. The ability of 10 candidate MCG predictors to predict normal/abnormal cases was analyzed using logistic regression. Predictive performance was internally validated using repeated five-fold cross-validation.

RESULTS

Three MCG predictors showed a significant difference between patients and age-matched controls (P<0.001); eight predictors showed a significant difference between patients and young healthy volunteers (P<0.001). Logistic regression comparing patients with controls yielded a specificity of 35.0%, sensitivity of 95.4%, and negative predictive value for the ruling-out of IHD of 97.8% (area under the curve 0.78).

CONCLUSION

This analysis represents a preliminary indication that the portable magnetometer can help rule-out healthy subjects and patients whose chest pain has a non-ischemic origin from those with IHD.

Radiation injury to cardiac arteries and myocardium is reduced by soy isoflavones

OBJECTIVE

The negative effects of incidental radiation on the heart and its vessels, particularly in the treatment of locally advanced non-small cell lung cancer, esophageal cancer, left-sided breast cancer, and lymphoma, are known. Late cardiac events induced by radiotherapy including coronary artery disease, ischemia, congestive heart failure, and myocardial infarction can manifest months to years after radiotherapy. We have previously demonstrated that soy isoflavones mitigate inflammatory responses induced in lungs by thoracic irradiation resulting in decreased vascular damage, inflammation, and fibrosis. In the current study, we investigate the use of soy isoflavones to protect cardiac vessels and myocardium from radiation injury.

METHODS

Mice received a single dose of 10-Gy thoracic irradiation and daily oral treatment with soy isoflavones. At different time points, hearts were processed for histopathology studies to evaluate the effect of soy isoflavones on radiation-induced damage to cardiac vessels and myocardium.

RESULTS

Radiation damage to arteries and myocardium was detected by 16 weeks after radiation. Soy isoflavones given in conjunction with thoracic irradiation were found to reduce damage to the artery walls and radiation-induced fibrosis in the myocardium.

CONCLUSION

Our histopathological findings suggest a radioprotective role of soy isoflavones to prevent cardiac injury. This approach could translate to the use of soy isoflavones as a safe complement to thoracic radiotherapy with the goal of improving the overall survival in patients whose cancer has been successfully controlled by the radiotherapy but who otherwise succumb to heart toxicity.

Irisin regulates cardiac physiology in zebrafish

Irisin is a myokine encoded in its precursor fibronectin type III domain containing 5 (FNDC5). It is abundantly expressed in cardiac and skeletal muscle, and is secreted upon the activation of peroxisome proliferator-activated receptor gamma coactivator-1 (PGC-1 alpha). We aimed to study the role of irisin on cardiac function and muscle protein regulation in zebrafish. Western blot analyses detected the presence of irisin protein (23 kDa) in zebrafish heart and skeletal muscle, and irisin immunoreactivity was detected in both tissues. Irisin siRNA treated samples did not show bands corresponding to irisin in zebrafish. In vitro studies found that treatment with irisin (0.1 nM) downregulated the expression of PGC-1 alpha, myostatin a, and b, while upregulating troponin C mRNA expression in zebrafish heart and skeletal muscle. Exogenous irisin (0.1 and 1 ng/g B.W) increased diastolic volume, heart rate and cardiac output, while knockdown of irisin (10 ng/g B.W) showed opposing effects on cardiovascular function. Irisin (1 and 10 ng/g B.W) downregulated PGC-1 alpha, myostatin a and b, and upregulated troponin C and troponin T2D mRNA expression. Meanwhile, knockdown of irisin showed opposing effects on troponin C, troponin T2D and myostatin a and b mRNAs in zebrafish heart and skeletal muscle. Collectively, these results identified muscle proteins as novel targets of irisin, and added irisin to the list of peptide modulators of cardiovascular physiology in zebrafish.

Common and rare variants associating with serum levels of creatine kinase and lactate dehydrogenase

Creatine kinase (CK) and lactate dehydrogenase (LDH) are widely used markers of tissue damage. To search for sequence variants influencing serum levels of CK and LDH, 28.3 million sequence variants identified through whole-genome sequencing of 2,636 Icelanders were imputed into 63,159 and 98,585 people with CK and LDH measurements, respectively. Here we describe 13 variants associating with serum CK and 16 with LDH levels, including four that associate with both. Among those, 15 are non-synonymous variants and 12 have a minor allele frequency below 5%. We report sequence variants in genes encoding the enzymes being measured (CKM and LDHA), as well as in genes linked to muscular (ANO5) and immune/inflammatory function (CD163/CD163L1, CSF1, CFH, HLA-DQB1, LILRB5, NINJ1 and STAB1). A number of the genes are linked to the mononuclear/phagocyte system and clearance of enzymes from the serum. This highlights the variety in the sources of normal diversity in serum levels of enzymes.

The Prognostic Value of High-Sensitive Troponin I in Stable Coronary Artery Disease Depends on Age and Other Clinical Variables

Objectives: To study the prognostic value of high-sensitive troponin (hs-cTn) I in stable coronary artery disease. Methods: In total, we studied 705 patients. Secondary outcomes were the incidence of: (1) acute ischemic events and (2) heart failure or death. The primary outcome was the composite of them. Results: Patients with hs-cTnI >0 ng/ml (62.1%) were older, had a lower estimated glomerular filtration rate, more frequent a history of hypertension, atrial fibrillation, ejection fraction <40%, and therapy with angiotensin-converting enzyme inhibitors, diuretics and acenocumarol. The follow-up period was 2.2 ± 0.99 years. Fifty-three patients suffered an acute ischemic event, 33 died or suffered heart failure and 78 developed the primary outcome. By univariate Cox's regression analysis, hs-cTnI >0 was associated with a higher risk of developing the primary outcome [relative risk = 2.360 (1.359-4.099); p = 0.001] and heart failure or death [relative risk = 5.932 (1.806-19.482); p < 0.001], but not with acute ischemic events. Statistical significance was lost after controlling for age. By logistic regression analysis, age [relative risk = 1.026 (1.009-1.044); p = 0.003], ejection fraction <40% [relative risk = 4.099 (2.043-8.224); p < 0.001], use of anticoagulants [relative risk = 2.785 (1.049-7.395); p = 0.040] and therapy with angiotensin-converting enzyme inhibitors [relative risk = 1.471 (1.064-2.034); p = 0.020], and estimated glomerular filtration rate [relative risk = 0.988 (0.977-0.999); p = 0.027] were associated with hs-cTnI >0. Conclusions: In stable coronary disease, hs-cTnI is associated with the incidence of heart failure or death, but this relationship depends on other variables.

Utility of Heart-type Fatty Acid Binding Protein as a New Biochemical Marker for the Early Diagnosis of Acute Coronary Syndrome

INTRODUCTION

Acute coronary syndrome (ACS) refers to a constellation of clinical symptoms caused by acute myocardial ischemia. Cardiovascular diseases (CVDs) are major and growing contributors to mortality and disability in India.

AIMS AND OBJECTIVES

Especially patients with non-ACS-related troponin elevations have an adverse outcome and require careful patient management. So, we look forward for another marker Heart-type Fatty Acid Binding Protein (H-FABP) that reliably detects myocardial ischemia in the absence of necrosis and would be useful for initial identification and for differentiating patients with chest pain of aetiology other than coronary ischemia.

MATERIALS AND METHODS

The study was done on 88 subjects of whom 34 subjects were with ischemic chest pain, 29 were with non-ischemic chest pain and 25 were normal subjects.

RESULTS

Receiver operating characteristic (ROC) curve analysis was done which showed that area under the curve (AUC) for H-FABP was 0.885(0.79-0.94) and that of high-sensitive Troponin T (hs-TnT) in initial six hours was 0.805(0.70-0.88). The specificity of H-FABP was higher compare to hs-TnT while sensitivity was comparable during 0-6 h of presentation of chest pain.

CONCLUSION

H-FABP can be used as an additional marker to hs-TnT in diagnosis of myocardial infarction (MI) and for exclusion of non-AMI (acute myocardial infarction) patients.