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Mortality from cardiovascular disease (CVD) accounts for over 30% of all deaths globally, necessitating reliable diagnostic tools. Prompt identification and precise diagnosis are critical for effective personalized treatment. Nanotechnology offers promising applications in diagnostics, biosensing and drug delivery for prevalent cardiovascular diseases. Its integration into cardiovascular care enhances diagnostic accuracy, enabling early intervention and tailored treatment plans. By leveraging nanoscale innovations, healthcare professionals can address the complexities of CVD progression and customize interventions based on individual patient needs. Ongoing advancements in nanotechnology continue to shape the landscape of cardiovascular medicine, offering potential for improved patient outcomes and reduced mortality rates from these pervasive diseases.

Background: COVID-19 has resulted in high mortality worldwide. Information regarding cardiac markers for precise risk-stratification is limited. We aim to discover sensitive and reliable early-warning biomarkers for optimizing management and improving the prognosis of COVID-19 patients., Methods: A total of 2954 consecutive COVID-19 patients who were receiving treatment from the Wuhan Huoshenshan Hospital in China from February 4 to April 10 were included in this retrospective cohort. Serum levels of cardiac markers were collected after admission. Coronary artery disease diagnosis and survival status were recorded. Single-cell RNA-sequencing and bulk RNA-sequencing from different cohorts of non-COVID-19 were performed to analyze SARS-CoV-2 receptor expression., Results: Among 2954 COVID-19 patients in the analysis, the median age was 60 years (50-68 years), 1461 (49.5%) were female, and 1515 (51.3%) were severe/critical. Compared to mild/moderate (1439, 48.7%) patients, severe/critical patients showed significantly higher levels of cardiac markers within the first week after admission. In severe/critical COVID-19 patients, those with abnormal serum levels of BNP (42 [24.6%] vs 7 [1.1%]), hs-TNI (38 [48.1%] vs 6 [1.0%]), α- HBDH (55 [10.4%] vs 2 [0.2%]), CK-MB (45 [36.3%] vs 12 [0.9%]), and LDH (56 [12.5%] vs 1 [0.1%]) had a significantly higher mortality rate compared to patients with normal levels. The same trend was observed in the ICU admission rate. Severe/critical COVID-19 patients with pre-existing coronary artery disease (165/1,155 [10.9%]) had more cases of BNP (52 [46.5%] vs 119 [16.5%]), hs-TNI (24 [26.7%] vs 9.6 [%], α- HBDH (86 [55.5%] vs 443 [34.4%]), CK-MB (27 [17.4%] vs 97 [7.5%]), and LDH (65 [41.9%] vs 382 [29.7%]), when compared with those without coronary artery disease. There was enhanced SARS-CoV-2 receptor expression in coronary artery disease compared with healthy controls. From regression analysis, patients with five elevated cardiac markers were at a higher risk of death (hazards ratio 3.4 [95% CI 2.4-4.8])., Conclusions: COVID-19 patients with pre-existing coronary artery disease represented a higher abnormal percentage of cardiac markers, accompanied by high mortality and ICU admission rate. BNP together with hs-TNI, α- HBDH, CK-MB and LDH act as a prognostic biomarker in COVID-19 patients with or without pre-existing coronary artery disease.

Myocardial infarction (MI) is one of the most important reason of mortality into worldwide. Visfatin is a novel adipokine which was reported increased in metabolic syndrome and obesity. Moreover, it is known that visfatin increases in aterosclerotic endotelial dysfunction. In our study we want to demonstrate how visfatin changes in isoproterenol (ISO) induced MI. Rats were allocated into 4 groups in which each group included 6 rats in this study. 200 mg/kg ISO was administered into rats except control group to induce MI. I. and II. Group rats in 6th hour, III. Group rats in 24th hour and IV. Group rats in 7th day were decapitated. Visfatin was searched in cardiac tissues of all groups by immunohistochemistry stainning. Visfatin and cardiac markers' levels were measured in serum samples. Serum visfatin levels gradually increased in 6th and 24th hour in MI rats compared to controls. In 7th day visfatin levels decreased to control levels. These changes correlated with serum troponin T levels. These findings were supported by immunohistochemistry stainning of visfatin in cardiac tissues. It has been shown that visfatin could be useful in diagnosing MI and may be a biomarker for cardiac ischemia because of increasing in systemic circulation and cardiac tissues in MI like troponins., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The detection of cardiac markers is critical to the diagnosis of acute myocardial infarction, and immunochromatographic assays are a common tool for point-of-care analysis. Methods : We report a multiplexed lateral flow test strip for simultaneous quantitative detection of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CKMB), and myoglobin (Myo). Hydrophilic, monodisperse, stable, and carboxyl-modified (COOH-) magnetic nanobeads (MNBs) were used to construct immunomagnetic probes specific to the three cardiac markers. The detection area of the sandwich-style complexes contained three test lines for cTnI, CKMB, and Myo. The magnetic signal intensity of the detection area in the nitrocellulose membrane was measured via a magnetic immunochromatography reader developed in house. Results : To optimize the assay, a modified working buffer was also investigated to improve the detection sensitivity, decrease the background noise, and shorten the detection time. The MNB-based immunochromatography test (MICT) strip offers a wide linear dynamic detection range, rapid detection, high sensitivity, and specificity. The limit of detection was 0.0089 ng/mL for cTnI, 0.063 ng/mL for CKMB, and 0.05 ng/mL for Myo with minimal cross-reactivity. There were 110 clinical human serum samples that were used to evaluate this platform with high correlation. Conclusion : MICT shows great potential as a supplemental method for in vitro diagnostics in the laboratory or in other point-of-care testing (POCT) applications., Competing Interests: Competing Interests: The authors have declared that no competing interest exists.

Neopterin has been considered as an important marker of cellular inflammation. The primary objective of the current study was to determine the role of neopterin in cardiovascular disease and its association with other well known cardiac markers. The study was composed of total 200 subjects (100 confirmed coronary artery disease (CAD) patients, 50 recently diagnosed, and 50 managed CAD patients) both men and women and 100 healthy control individuals of matching age and weight. Serum neopterin analysis was done using commercial available ELISA kits. Other cardiac markers viz. troponin, creatine kinase (CK), CK MB isoenzyme (CKMB), lactate dehydrogenase (LDH), fibrinogen, C-reactive protein (CRP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) estimation was done by standard routine biochemical methods. Neopterin level was found to be remarkably enhanced by 150% and 513% in the recently diagnosed and managed CAD patients, respectively. CK level also showed a significant rise by 62% in the managed patients. However, recently diagnosed patients did not show any significant change. Moreover, cross correlation study showed statistically significant (P < 0.01) change in neopterin and CK levels between recently and managed patients. In the other studied CAD markers such as CKMB, fibrinogen and LDH also showed a significant increase in both categories of patients. CRP level was also found to be significantly enhanced by 357% (P < 0.01) and 341% (P < 0.05) in recently diagnosed and managed patients respectively. Because of cost effectiveness, easy and quick analysis of neopterin in the serum sample, we propose neopterin as the prognostic as well as diagnostic biomarker of CAD before other markers could be tested especially in Saudi population., (© 2015 International Union of Biochemistry and Molecular Biology.)

In the review, authors discussed recently published experimental data concerning highly sensitive electrochemical methods and technologies for biomedical investigations in the postgenomic era. Developments in electrochemical biosensors systems for the analysis of various bio objects are also considered: cytochrome P450s, cardiac markers, bacterial cells, the analysis of proteins based on electro oxidized amino acids as a tool for analysis of conformational events. The electroanalysis of catalytic activity of cytochromes P450 allowed developing system for screening of potential substrates, inhibitors or modulators of catalytic functions of this class of hemoproteins. The highly sensitive quartz crystal microbalance (QCM) immunosensor has been developed for analysis of bio affinity interactions of antibodies with troponin I in plasma. The QCM technique allowed real-time monitoring of the kinetic differences in specific interactions and nonspecific sorption, with out multiple labeling procedures and separation steps. The affinity binding process was characterized by the association (ka) and the dissociation (kd) kinetic constants and the equilibrium association (K) constant, calculated using experimental data. Based on the electroactivity of bacterial cells, the electrochemical system for determination of sensitivity of the microbial cells to antibiotics cefepime, ampicillin, amikacin, and erythromycin was proposed. It was shown that the minimally detectable cell number corresponds to 106 CFU per electrode. The electrochemical method allows estimating the degree of E.coli JM109 cells resistance to antibiotics within 2-5 h. Electrosynthesis of polymeric analogs of antibodies for myoglobin (molecularly imprinted polymer, MIP) on the surface of graphite screen-printed electrodes as sensor elements with o- phenylenediamine as the functional monomer was developed. Molecularly imprinted polymers demonstrate selective complementary binding of a template protein molecule (myoglobin) by the "key-lock" principle.

Laboratory testing for blood-based biomarkers of myocardial injury has steadily evolved over the past 60 years. Initial assays were cumbersome and were neither sensitive nor specific for myocardial necrosis. Major improvements have included the development of more cardiospecific markers, the introduction of random access immunoassays that facilitated near-real-time reporting of results, the development of rapid whole-blood point-of-care testing, and progressive improvements in assay design leading to modern high-sensitivity troponin assays that are now being introduced to the market. These new high-sensitivity assays will dramatically change the approach to patients presenting with acute coronary syndromes., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Antibody-based tests are the primary technology used for clinical measurement of cardiac biomarkers in peripheral circulation. This article focuses on the principles of immunometric methods that have been applied to cardiac biomarkers of widespread clinical utility (CKMB, Troponins, and B-type natriuretic proteins) and of more recent clinical testing (ST2, Galectin-2, and myosin binding protein C). How these principles are applied in the design of immunometric assays and how they influence assay performance in quantifying cardiac biomarkers in biologic fluids (serum or plasma) is discussed., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background Cardiac injury caused by iron overload is the leading cause of mortality and morbidity in patients with beta-thalassemia, owing to frequent blood transfusion, increased iron overload, and blood hemolysis. Objective This research aimed to assess several novel cardiac biomarkers in the blood samples of children and adult patients with beta-thalassemia major (βTM), along with their respective control groups. These biomarkers included endothelin 1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), growth differentiation factor-15 (GDF-15), and renalase (RNLS). Methods This case-control study was done on 46 patients with βTM (23 children <18 years, and 23 adults ≥18 years) from the Genetic Hematology Center in Thi-Qar province, Iraq, and 42 comparable controls in 2 groups (21 for each group) in the period from February to April 2023. Results Levels of ET-1, NT-proBNP, ANP, GDF-15, RNLS, and ferritin were higher in the children and adults with βTM than in the control subjects. Conclusion Elevations of the novel cardiac biomarkers ET-1, NT-proBNP, ANP, GDF-15, and RNLS in the sera of children and adult patients with βTM when compared with comparable control subjects confirm that the majority of patients with βTM are at risk of cardiac and cardiovascular complications even when there are no obvious symptoms, especially in children, which gives suitable predictive biomarkers. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of cardiovascular disease (CVD) has been continuously increasing, and this trend is projected to continue. CVD is rapidly becoming a significant public health issue. Every year there is a spike in hospital cases of CVD, a critical health concern in lower- and middle-income countries. Based on identification of novel biomarkers, it would be necessary to study and evaluate the diagnostic requirements or CVD to expedite early detection. Main body The literature review was written using a wide range of sources, such as well-known medical journals, electronic databases, manuscripts, texts, and other writings from the university library. After that, we analysed the specific markers of CVD and compiled a systematic review. A growing body of clinical research aims to identify people who are at risk for cardiovascular disease by looking for biomolecules. A small number of biomarkers have been shown to be useful and reliable in medicine. Biomarkers can be used for a variety of clinical applications, such as predicting heart disease risk, diagnosing disease, or predicting outcomes. As a result of the ability for a single molecule to act as a biomarker, its usefulness in medicine is expected to increase significantly. Conclusions Based on assessing the current trends in the application of CVD markers, we discussed and described the requirements for the application of CVD biomarkers in coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other cardiovascular illnesses. Furthermore, the current review focuses on biomarkers for CVD and the procedures that should be considered to establish the comprehensive nature of the expression of biomarkers for cardiovascular illness.

Background: The prevalence of cardiovascular disease (CVD) has been continuously increasing, and this trend is projected to continue. CVD is rapidly becoming a significant public health issue. Every year there is a spike in hospital cases of CVD, a critical health concern in lower- and middle-income countries. Based on identification of novel biomarkers, it would be necessary to study and evaluate the diagnostic requirements or CVD to expedite early detection. Main body: The literature review was written using a wide range of sources, such as well-known medical journals, electronic databases, manuscripts, texts, and other writings from the university library. After that, we analysed the specific markers of CVD and compiled a systematic review. A growing body of clinical research aims to identify people who are at risk for cardiovascular disease by looking for biomolecules. A small number of biomarkers have been shown to be useful and reliable in medicine. Biomarkers can be used for a variety of clinical applications, such as predicting heart disease risk, diagnosing disease, or predicting outcomes. As a result of the ability for a single molecule to act as a biomarker, its usefulness in medicine is expected to increase significantly. Conclusions: Based on assessing the current trends in the application of CVD markers, we discussed and described the requirements for the application of CVD biomarkers in coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other cardiovascular illnesses. Furthermore, the current review focuses on biomarkers for CVD and the procedures that should be considered to establish the comprehensive nature of the expression of biomarkers for cardiovascular illness. [ABSTRACT FROM AUTHOR]

Simple Summary: Trastuzumab administered as a (neo)adjuvant therapy in radically treated Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer patients improves overall survival. This study aimed to assess if factors commonly thought to play a role as biomarkers of trastuzumab-induced cardiotoxicity (TIC) are pathognomonic for this injury. Data obtained for 130 HER2-positive breast cancer patients do not support an influence of N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), or myoglobin on the frequency of TIC. Suggestions for trastuzumab therapy include: close cooperation between cardiologists and oncologists; not using NT-proBNP, CK-MB, or myoglobin as standard TIC predictive markers; organizing prospective studies assessing the role of these parameters as TIC predictive markers in the case of HER2 blockage in conjunction with doublet immunotherapy or other anti-HER2 agents. Trastuzumab-induced cardiotoxicity (TIC) can lead to early treatment discontinuation. The aim of this study was to evaluate: N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), myoglobin, and selected biochemical and clinical factors as predictors of TIC. One hundred and thirty patients with HER2-positive BC receiving adjuvant trastuzumab therapy (TT) were enrolled. Measurement of cardiac markers and biochemical tests as well as echocardiography were performed prior to TT initiation and every three months thereafter. Cardiotoxicity leading to treatment interruption occurred in 24 patients (18.5%). While cardiotoxicity caused early treatment discontinuation in 14 patients (10.8%), the TIC resolved in 10 (7.7%) and TT was resumed. The most common complication was a decrease in left ventricular ejection fraction of more than 10% from baseline or below 50% (7.7%). In patients with TIC, there was no increase in the levels of NT-proBNP, myoglobin, and CK-MB. BMI, hypertension, ischemic heart disease, diabetes, age, cancer stage, type of surgery, use of radiotherapy, chemotherapy, and hormone therapy were shown to not have an effect on TIC occurrence. NT-proBNP, myoglobin, and CK-MB are not predictors of TIC. There is an ongoing need to identify biomarkers for TIC. [ABSTRACT FROM AUTHOR]

Platinum-containing nanozymes with peroxidase-mimicking activity (PMA) have found a broad application in bioanalytical methods and are potentially able to compete with enzymes as the labels. However, traditionally used methods for the synthesis of nanozymes result in only a small fraction of surface-exposed Pt atoms, which participate in catalysis. To overcome this limitation, we propose a new approach for the synthesis of nanozymes with the efficient dispersion of Pt atoms on particles' surfaces. The synthesis of nanozymes includes three steps: the synthesis of gold nanoparticles (Au NPs), the overgrowth of a silver layer over Au NPs (Au@Ag NPs, 6 types of NPs with different thicknesses of Ag shell), and the galvanic replacement of silver with PtCl62− leading to the formation of trimetallic Au@Ag-Pt NPs with uniformly deposited catalytic sites and high Pt-utilization efficiency. Au@Ag-Pt NPs (23 types of NPs with different concentrations of Pt) with various sizes, morphology, optical properties, and PMA were synthesized and comparatively tested. Using energy-dispersive spectroscopy mapping, we confirm the formation of core@shell Au@Ag NPs and dispersion of surface-exposed Pt. The selected Au@Ag-Pt NPs were conjugated with monoclonal antibodies and used as the colorimetric and catalytic labels in lateral flow immunoassay of the inflammation biomarker: C-reactive protein (CRP). The colorimetric signal enhancement was achieved by the oxidation of 3,3′-diaminobenzidine by H2O2 catalyzed by Au@Ag-Pt NPs directly on the test strip. The use of Au@Ag-Pt NPs as the catalytic label produces a 65-fold lower limit of CRP detection in serum (15 pg mL−1) compared with Au NPs and ensures the lowest limit of detection for equipment-free lateral flow immunoassays. The assay shows a high correlation with data of enzyme-linked immunosorbent assay (R2 = 0.986) and high recovery (83.7–116.2%) in serum and plasma. The assay retains all the benefits of lateral flow immunoassay as a point-of-care method. [ABSTRACT FROM AUTHOR]

The current investigation aimed to test the alterations of the levels of obestatin hormone, lipid profile and cardiac function markers in relation to hyperglycemia in patients with non-insulin diabetes mellitus. The study included 118 diabetic subjects (56 males, 62 females) and 60 healthy non-diabetic subjects (30 males, 30 females). Diabetic and healthy subjects were age-matched. Serum levels of obestatin, lipid profile markers including total cholesterol (STC), triglycerides (STG), low and high density lipoproteins (LDL-C and HDL-C), as well as cardiac function markers including, creatine kinase and lactate dehydrogenase enzymes were determined in all subjects. The findings revealed a remarkable decrease in the level of serum obestatin in both diabetic males and females with both age ranges (40-59 and 60-80 years). On the other hand, the results showed that serum STC, LDL-C, and STG levels were statistically significantly elevated, while that for HDL-C was significantly decreased in diabetic males and females with both age ranges. Concerning the cardiac markers, the results found out that the levels of CK-MB and LDH were significantly increased in type 2 diabetic males and females with both age ranges. The results suggested that a low concentration of obestatin is a significant risk factor for type 2 DM, with a key role for this hormone in the pathogenesis. Accordingly, altered levels of obestatin could be used as an important indicator for type 2 DM. The current study also suggests a direct relationship between lipid profiles, except for HDL, the decreased obestatin level, the increased cardiac function markers, and hyperglycemic status in type 2 DM. [ABSTRACT FROM AUTHOR]

We have developed a novel cardiac multibiomarker detection system, wherein cardiac biomarkers NT-proBNP and cTnI could be detected simultaneously in 20 min. The lower limits of detection of NT-proBNP and cTnI were 0.33 and 1.43 pg/ml, respectively. Furthermore, based on a microfluidic chip and a giant magnetoresistance sensor, the detecting system was realized in a small platform to decrease the manufacturing cost and the difficulty of operation. In addition, owing to the usage of the superparamagnetic nanoparticles of suitable diameter and bovine serum albumin blocker in nanoparticles solution, the system achieved a high signal-to-noise ratio in the whole dynamic range. This magnetic immunoassay system can be adapted to detect a variety of clinically important biomolecules in human samples and provide accurate information to diagnose human diseases. [ABSTRACT FROM AUTHOR]

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Dilated cardiomyopathy occurs more frequently in large breed of dogs and the common form is the Idiopathic Dilated Cardiomyopathy. Xanthine oxidase is considered as one of the potent enzyme causing oxidative stress in the failing heart, and it uncouples cardiac energy consumption from cardiac contraction resulting in heart failure. In the present study xanthine oxidase activity was estimated in the serum of Dilated cardiomyopathy affected dogs and compared with that of healthy dogs serving as control. Similarly, other known cardiac enzyme markers like creatine kinase, aspartate transaminase and lactate dehydrogenase activities were also estimated. The results showed a 300% increase in the specific activity of xanthine oxidase and a 200% increase in the total activity of xanthine oxidase. This indicates that measurement of xanthine oxidase activity can serve as an early biochemical marker for diagnosis of Dilated cardiomyopathy in canines. [ABSTRACT FROM AUTHOR]

We measured the level of cardiac markers (high-sensitivity troponin T and MB fraction of creatine kinase) in children of the first year of life with congenital heart disease in the perioperative period. After cardiac surgery, plasma levels of the above markers exceed the reference limits in the examined children. The diagnosis of myocardial ischemia using biochemical markers in the postoperative period is possible only by dynamic monitoring of the cardiac marker level. The preoperative concentration of high-sensitivity troponin T in children of the first year of life with congenital heart disease can be regarded as a predictor of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Serum cardiac troponin T (cTnT) is a valuable marker of ischemic heart disease (IHD) and left ventricular hypertrophy, as well as a mortality predictor in hemodialysis populations. We compared the value of cTnT, creatinine kinase (CK)-MB mass and myoglobin as mortality predictors in our hemodialysis patients and evaluated their relation to nutritional status. Methods: A total of 118 hemodialysis patients were prospectively studied from January 2004 to April 2013. Clinical and laboratory evaluations during the 12-month baseline period included the history of IHD, signs of left ventricular hypertrophy (LVH), Kt/V and serum cardiac markers together with the percentage of body fat (%fat), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skinfold (TSF) and BMI. Results: Underweight patients had significantly higher cTnT values (Mann-Whitney, p < 0.05). Correlation analysis (Spearman) showed an inverse association between cTnT and TSF (ρ = −0.22, p < 0.05), as well as between CK-MB mass and TSF (ρ = −0.26, p < 0.01). In men cTnT also correlated inversely with %fat (ρ = −0.27, p < 0.05) and BMI (ρ = −0.33, p < 0.05). In addition, myoglobin was correlated significantly with MAC, MAMC and albumin. Among cardiac markers cTnT was the only independent variable predicting mortality (Multivariate Cox regression, HR = 1.04 CI (1.01-1.07); p < 0.01; measurement units 0.01 μg/L). Conclusion: Troponin T and CK-MB mass were significantly elevated in the underweight patient group. Troponin T was the only independent cardiac marker predictor of all cause mortality in our hemodialysis patients. [ABSTRACT FROM AUTHOR]

Abstract: Cardiac mitochondrial damage plays an important role in the pathology of myocardial infarction. The protective effects of (−) epicatechin on cardiac mitochondrial damage in isoproterenol induced myocardial infarction were evaluated in rats. Rats were pretreated with (−) epicatechin (20mg/kg body weight) daily for a period of 21days. After the pretreatment period, isoproterenol (100mg/kg body weight) was injected subcutaneously into rats twice at an interval of 24h to induce myocardial infarction. Isoproterenol induced myocardial infarcted rats showed a significant increase in the levels of cardiac diagnostic markers, heart mitochondrial lipid peroxidation, calcium, and a significant decrease in the activities/levels of heart mitochondrial glutathione peroxidase, glutathione reductase, reduced glutathione, isocitrate, succinate, malate, α-ketoglutarate and NADH-dehydrogenases, cytochrome-C-oxidase and adenosine triphosphate. (−) Epicatechin pretreatment showed significant protective effects on all the biochemical parameters evaluated. The in vitro study revealed the superoxide and hydroxyl radical scavenging activity of (−) epicatechin. The possible mechanisms for the beneficial effects of (−) epicatechin on cardiac mitochondria could be attributed to scavenging of free radicals, decreasing calcium, increasing multi-enzymes (antioxidant, tricarboxylic acid cycle and respiratory chain enzymes), reduced glutathione and adenosine triphosphate. Thus, (−) epicatechin attenuated mitochondrial damage in isoproterenol induced myocardial infarcted rats. [Copyright &y& Elsevier]

Abstract: This study investigates the antihyperlipidemic effect of ursolic acid (UA) on isoproterenol (ISO) induced male albino Wistar rats. Myocardial ischemia was induced by subcutaneous injection of ISO (85mg/kg BW) twice at an interval of 24h, for two consecutive days. A significant increase in the activities of the serum marker enzymes [creatine kinase, creatine kinase-MB and lactate dehydrogenease (LDH)], a prominent expression of LDH 1 and LDH 2 isoenzymes, increased levels of plasma total cholesterol (TC), low density lipoprotein-cholesterol, very low density lipoprotein-cholesterol, triglycerides (TG), free fatty acids (FFA), phospholipids (PL) and atherogenic index and decreased level of high density lipoprotein-cholesterol were observed in ISO-induced rats. The levels of TC, TG and FFA increased and the level of PL decreased in the heart tissue of ISO-induced rats. Further, there was an increased DNA damage (Comet assay) and myocardium infarct size as observed by staining with triphenyltetrazolium chloride (TTC). UA was administered subcutaneously for 7days at a dose of 40mg/kg BW. UA administration to ischemic rats brought all these parameters to near normality showing the protective effect of UA on ISO-induced rats. [Copyright &y& Elsevier]

Abstract: Background: We evaluated the utility of an independent biomarker of early ischemic cellular damage—circulating fractional forms of C-reactive protein (fracCRP), to verify the diagnostic relevance of low Troponin I (TnI) values within the context of a workup for Acute Coronary Syndrome (ACS). Methods: On a semi-preparative scale, the molecular characteristics of fracCRP were established by electron microscopy and Western Blot, using isolates captured from patient serum on phosphorylcholine beads and purified by size exclusion high-pressure liquid chromatography (SE-HPLC). Captured on an analytical scale, the diagnostic utility of fracCRP was evaluated in first-draw plasma specimens (total CRP not exceeding 6mg/l) recovered from 300 cardiac emergency patients with final discharge diagnoses of ACS ruled out (N=132) or ruled in (N=168). Results: At a cutoff value chosen for 97.7% test specificity, the test metric (fracCRP×TnI) identified in the first blood draw 39.9% of all emergency patients ultimately diagnosed with ACS, and 17.9% of ultimately diagnosed patients who arrived with TnI values within the normal reference range (0.01–0.04ng/ml). Conclusions: These findings suggest that the fracCRP test metric could serve as a rule-in test for ACS in a significant proportion of low to moderate risk emergency patients. [Copyright &y& Elsevier]

The article offers information on the study conducted by researchers including J. Scherr, S. Braun, and T. Schuster on cardiac biomarkers that are increased by strenuous exercise. It states that, scientists have not been able to find out the real cause behind cardiac biomarkers, which they think may be influenced by two factors including cardiomyocyte necrosis or secondary mechanisms like ischemia, cardiac energy deficiency, and increased inflammation. This study involves the analysis of some biomarkers including cardiac biomarkers, inflammation markers, and interleukin-6.

Abstract: This work describes the application of a newly emerged biosensing configuration incorporating a Surface Acoustic Wave device integrated with a multi-channel microfluidic module for the rapid and efficient analysis of cardiac markers. The examined cardiac markers of creatine kinase MB (CK-MB), cardiac reactive protein (CRP), D-dimer and pregnancy-associated plasma protein A (PAPP-A), comprise a group of both established and emerging heart disease proteins, that has never been probed before with any kind of biochip-related platform. The four markers were successfully detected; kinetics and affinity studies on their interactions with the surface immobilized antibodies are also presented. A concentration detection limit of less than 1nM was achieved, with a dynamic range of more than two orders of magnitude, covering some of the pathological and healthy areas of interest. Mixtures of biomarkers applied to the device surface were used to prove the specificity of each binding event and investigate the microsystem''s performance in the presence of complex fluids, towards future utilization with real samples. The simplicity and multiplexing ability of the integrated platform render the system ideal as a potential diagnostic tool for cardiovascular risk assessment, where simultaneous analysis of various protein markers is required. [Copyright &y& Elsevier]

Abstract: Background: Studies of cardiac markers in diagnosing acute myocardial infarction (AMI) have mostly been performed using central laboratory platforms. The AQT90 FLEX TnI (troponin I) assay is designed for quantitative point of care testing (POCT). This study evaluated clinical performance in diagnosing AMI of the AQT90 FLEX TnI POCT assay compared with central laboratory troponin assays. Methods: The study included 458 chest pain patients. Blood samples were obtained on admission and after 6–9h. Blood was analyzed using the following assays: AQT90 FLEX TnI, Access AccuTnI, Abbott AxSYM ADV, Roche cTnT, Roche CKMBmass. Patients were diagnosed with AMI according to the new universal definition of AMI. Results: The performance of the AQT90 FLEX TnI assay on admission was equivalent to the Abbott AxSYM ADV cTnI but inferior to the AccuTnI. After 6–9h both laboratory based assays were superior. The AQT90 FLEX TnI had a negative predictive value (NPV) of 90 and 96% (admission; 6–9h). No statistical differences were seen in receiver operating characteristics analysis. Conclusions: The AQT90 FLEX TnI POCT assay was marginally inferior to the two laboratory based assays of cTnI in diagnosing AMI. A high (NPV) may make this assay suitable as a rule out marker. [Copyright &y& Elsevier]

Aims: Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) is a strong biochemical marker of heart failure and left ventricular dysfunction (LVD). Due to renal arterio-venous clearance of NT-proBNP and the correlation of plasma concentrations with renal function, we hypothesized that NT-proBNP may have potential as a urinary marker. The objective of this study was to assess urinary concentrations of NT-proBNP and to identify the predictive value of urinary NT-proBNP for detecting LVD and heart failure. [ABSTRACT FROM PUBLISHER]

The increased analytical sensitivity of the new generation of methods for cardiac troponin I (cTnI) and T (cTnT) has demonstrated that measurable troponin is present in the blood of healthy adult subjects. These data are not in accordance with the prevailing opinion that any reliably detected increase in cardiac troponins should be considered abnormal and potentially caused by cardiac necrosis. The goal of the present review is to discuss the hypothesis that cardiac troponins can be released from cardiomyocytes, even in healthy adult subjects as a result of a process related to “physiological renewal” of the human myocardium and possibly enhanced by physical exercise or aging. The latest generation of high-sensitive cTnI and cTnT immunoassays are characterized by detection limits (DLs) as low as a few picograms. This clearly represents a greater increase in discrimination than that obtained by the most sophisticated cardiac imaging techniques that are commercially available at present. However, the critical question is whether high-sensitive troponin assays are clinically useful and in particular, whether some specific laboratory biomarkers (such as cTnI and cTnT) yield better diagnostic (or prognostic) accuracy and cost-effectiveness when compared with echocardiography in patients with cardiovascular disease. Only specific and well-designed clinical trials will answer this important question. Clin Chem Lab Med 2009;47:1167–77. [ABSTRACT FROM AUTHOR]

The contractile sarcomeric pool of skeletal muscle and heart consists of a highly-ordered arrangement of actin thin filaments, tropomyosin and proteins of the troponin complex: troponin I (TnI), troponin T (TnT) and troponin C (TnC). The cardiac myocyte expresses specific isoforms of both TnI and TnT (cTnI and cTnT, respectively), which can be distinguished from skeletal muscle isoforms by rapid and reliable immunoassays. Due to their superior cardiac specificity, cTnI and cTnT have become the recommended biomarkers for the diagnosis of myocardial injury. The most common applications are for risk stratification and diagnosis of acute coronary syndromes, albeit they can also be used for assessing a variety of other myocardial disorders. However, the excellent diagnostic efficiency of cardiac troponin testing is jeopardized by some pre-analytical issues (unsuitable specimens for testing, analyte stability, handling, transportation and storage of specimens prior to analysis), as well as by analytical concerns related to standardization or harmonization of cTnI immunoassays, imprecision at low concentrations, antibody specificity, immunoreactivity of plasma isoforms released in the blood after myocardial injury, interference from autoantibodies, heterophilic antibodies, rheumatoid factor, and human anti-mouse antibodies. In addition, although the influence of some known mutations in cTnT and cTnI on calcium sensitivity and force generation have been readily demonstrated, their influence on current immunoassays is unknown. Most mutations in these proteins may contribute to the development of certain cardiomyopathies, namely hypertrophic and restrictive. In these situations, the phenotype is characterized by the underlying diseases, and the ability to detect cTnT or cTnI is of relatively little clinical significance. However, the cTnT Arg129Lys polymorphism and those observed in the stable domain of cTnI do not significantly alter the functional properties of the molecule within the myocardium and thus are predictably asymptomatic. While the actual prevalence of these polymorphisms in the general population is still unknown, they might be a source of potential analytical problems; modifying the immunogenicity of the molecule and leading to potential false negative results. The goal of this article is to provide an overview on the potential technical and analytical challenges in the measurement of cardiac troponins, along with the significance of polymorphisms in the genes encoding for cTnI and cTnT in both health and disease. Clin Chem Lab Med 2009;47:1183–94. [ABSTRACT FROM AUTHOR]

Abstract: Background: Release kinetics of ischaemia modified albumin (IMA) have not been described in detail and never in ongoing acute coronary syndrome. We compared IMA kinetics with early necrosis biomarkers during ST-segment elevation myocardial infarction (STEMI) and in different populations with ischaemic heart disease and healthy subjects. Methods: We investigated 1. patients with ongoing STEMI (n =25), 2. patients with non-ST segment elevation MI (n =5), 3. patients with stable angina (n =5), and 4. healthy subjects (n =5). Groups 1–3 underwent percutaneous coronary intervention (PCI). Fourteen blood samples were collected, of which 11 were obtained during the first 24 h following PCI. Samples were analyzed for IMA, cardiac troponin T, CKMB mass, myoglobin, and heart-type fatty acid binding protein. Results: In the STEMI group, mean IMA increased to 16% above upper limit of normal, peaking 40 min after PCI, and nearly normalizing within 2.5 h. Relative concentrations of IMA were low compared to other cardiac biomarkers. In all other groups, changes were non-significant. Conclusions: IMA is a marker of cardiac ischaemia with rapid clearance and a narrow diagnostic time window that may decrease NPV and clinical usefulness due to its dependency of short symptoms duration. Sensitivity of the assay was low compared to other markers. [Copyright &y& Elsevier]

Abstract: Background: Cardiac markers are a cornerstone for assessment of suspected acute coronary syndrome (ACS) patients. The National Academy for Clinical Biochemistry has recently developed practice guidelines for clinical, analytical and point-of-care (POC) testing in the context of ACS. Several technologies have become available for POC applications. Setting: Cardiac troponin is the preferred biochemical marker for diagnosis, risk stratification and guiding management of suspected ACS patients. Samples must be collected with proper timing, typically on presentation and then 6 to 9 h later. Assays should work toward a goal of total CV <10% at the 99th percentile cutpoint, and should adhere to specifications defined by professional organizations. A 1-h or less turnaround time is specified; quantitative POC testing should be implemented if this timing cannot be met consistently by the central laboratory. The same quality criteria for assays apply regardless of testing venue. Implementation/management: Laboratory medicine personnel must have active role in implementation, choice of technology and management of POC cardiac marker testing. Conclusions: Cardiac troponin measurements at POC are a viable alternative when testing needs cannot be met by the central laboratory. Laboratory medicine must be involved in implementation and ongoing service. Quality of testing must not be compromised by performance at POC. [Copyright &y& Elsevier]

Cardiac troponin release is generally found in adult athletes after continuous-type endurance exercises or sport competitions. The purpose of this study was to investigate whether the physical stress experienced by adolescents while playing basketball, an intense, intermittent-type sport, could induce transient elevations of the serum cardiac troponin T (cTnT) and I (cTnl). Serum cTnT and cTnl levels in 10 male adolescent players (age 15.0 ± 0.7 yr) were assessed immediately before and at 2,4 and 24 h after a game randomly selected from a preseason basketball-training program. At 4 h following the game, serum cTnT levels in four of the ten subjects were above the cutoff of 0.01 ng·ml-1 for myocardial injury. Two of these four subjects had values higher than the acute myocardial infarction cutoff of 0.05 ng·ml-1. In three of the four subjects, the serum cTnl was above the cutoff of 0.06 ng·ml-1 for myocardial injury. Nevertheless, serum cardiac troponins at 24 h had returned to pre-exercise levels. These findings suggest that the physical stress encountered during intense, intermittent-type sports could cause release of cardiac troponins in some adolescents at low risk for cardiac disease. [ABSTRACT FROM AUTHOR]

Timely identification of patients with patent infarct-related artery (IRA) may permit rapid triaging to avoid unnecessary repeat thrombolysis or rescue percutaneous coronary intervention (PCI). Various biomarkers have been proposed to assess IRA patency status. Our group found that the ratio of serum myoglobin levels obtained before and 60-rain after initiation of thrombolytic therapy may provide an early indication of the IRA patency status. A 60-min myoglobin ratio of ≥ 4.0 indicated the probability of a patent IRA of 90%, suggesting that follow-up diagnostic modalities such as emergency coronary angiography to determine the IRA status may he unnecessary when these dynamics of myoglobin are observed. [ABSTRACT FROM AUTHOR]

Objectives . To investigate the diagnostic approach in Nordic hospitals receiving patients suspected of acute myocardial infarction (MI), especially focusing on implementation of the recently proposed criteria by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) for the definition of MI. Design . A survey with questionnaires of the diagnostic approach was conducted among all relevant departments (220) in the Nordic countries. Results . Seventy-six percent (167) of hospitals responded. Troponins I and T (TnI and TnT) and creatinine kinase monobasic fraction (mass concentration) (CKMB mass ) covered 93 and 65% of hospitals, respectively. Of troponin users, 34% indicated use of TnI vs 66% using TnT. Sporadic use of AST, CK, LD and myoglobin was reported. There was a tendency to lower cut-off levels in Sweden and Finland. Among troponin assays, there was considerable heterogeneity regarding cut-off levels. Conclusions . The Nordic countries are approaching ESC/ACC consensus on cardiac markers. Compared with previous national surveys (1995–1999), there is a shift towards the use of troponins. However, differences in cut-off levels of troponin emphasize the need for harmonization of assays. [ABSTRACT FROM AUTHOR]

Abstract: Considerable effort by clinicians and scientists focuses on the utility of biomarkers to prevent, diagnose and manage adverse cardiac events as well as provide information on a specific patient''s underlying pathology. Although troponins I and T (TnI and TnT) are cardiac specific markers that yield diagnostic and prognostic value in patients with myocardial injury, troponins cannot be utilized in all clinical settings. Troponins have limited utility for the diagnosis of early ischemia and preoperative myocardial infarction. Troponin T also lacks specificity in patients with renal failure. New markers, such as ischemia modified albumin (IMA) and CD40 ligand, and new technologies, such as proteomics, are under investigation to advance our knowledge of heart disease. [Copyright &y& Elsevier]

In 1999 the Centre of Biomedical Research (CRB) in co-operation with the Italian interdisciplinary and intersociety Working Group on Markers of Myocardial Damage proposed a national external quality assurance scheme that was granted in accordance with the UK Clinical Pathology Accreditation Standards in 2001. The scheme, which stresses the importance of educational aspects in quality assurance, was scientifically designed to ensure that it would provide an objective assessment of participants' performance and promote quality improvements to meet the needs of participants. The present paper reports on the data collected in EQA cycles conducted to evaluate improvements in the performance of participants and in related methods. The findings obtained demonstrate that during the 4-year experience the scheme provided opportunities to improve the performance of laboratories and promoted an efficient, more satisfactory approach to analytical aspects. The number of unacceptable performances decreased from 11.6% to 5.6% for troponin I, from 19.5% to 9.0% for myoglobin and from 13.2% to 4.3% for creatine kinase myocardial isoenzyme (CK-MB). During cycles in 2001 and 2002, inter-variability (coefficient of variation, CV%) data for all markers appeared satisfactory and showed a significant improvement (lower than 10%), in particular for procedures automated on Dade Beh- ring Dimension and Beckman Access systems. How- ever, reference values/decisional limits declared by laboratories and those suggested by the manufacturers are not comparable, even within the same diagnostic system. The findings demonstrate that participation in EQA schemes provided an opportunity for participating laboratories to continuously improve the quality of their services. [ABSTRACT FROM AUTHOR]

Conflicting data in the literature concern possible differences in the immunochemical measurement of cardiac troponins, either in plasma or in serum. In order to address this specific point, 96 serum and heparin- plasma pairs were obtained for cardiac marker measurement [cardiac troponin I (cTnT); myoglobin (Myo) and creatine kinase-MB isoenzyme (CK-MB)]; 29 additional "common" analytes were measured in 77 such samples. The cardiac markers were measured by electrochemiluminescence (Elecsys 2010, Roche); the other analytes by established automated methods (Modular, Roche). Mean plasma/serum ratios for cTnT (0.95), creatine kinase-MB (1.01) and myoglobin (0.99) were comparable with those of the 29 common analytes (interval of means 0.83-1.05). The distribution of the plasma-serum differences also showed similarities between cardiac markers and other analytes. A few outlier plasma-serum differences (3-5%) were measured for both categories of analytes. Addition of heparin to serum (51 samples) caused decreased cTnT (mean ratio 0.92). In 3 of 51 such samples the cTnT decrease was more marked, but in a second sample from the same subjects (1 week later) such a prominent, heparin-induced loss of cTnT no longer appeared. In conclusion, plasma-serum differences in immuno-reactive cTnT compare with those observed for other analytes. In occasional heparin-plasma samples immunochemical measurement of cTnT may give exceptionally low values. However, in our sample group of 96 patients (cTnT lower or higher than the cut-off in, respectively, 24 and 72 patients), no misclassification occurred if plasma instead of serum cTnT values were considered. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to determine myocardial injury in patients with septic shock by measuring serum cardiac troponin I (cTnI), to evaluate relationship between elevated cTnI and myocardial dysfunction and to determine if cTnI is a predictor of outcome in these patients. Methods: Thirty-seven consecutive patients with septic shock were included in the study. Serum cTnI was measured at study entry and after 24 and 48 h. Transthoracic echocardiogram, electrocardiogram and regular biochemical and hemodynamic assessments were performed. Results: Sixteen (43%) patients had elevated serum cTnI. These patients had higher need for inotropic/vasopressor support (94% vs. 53%, p=0.018), higher APACHE II score (28 vs. 20, p=0.004), higher incidence of regional wall motion abnormalities on echocardiography (56% vs. 6%, p=0.002), lower ejection fraction (46% vs. 62%, p=0.04) and higher mortality (56% vs. 24%, p=0.04) compared to normal cTnI patients. By multiple logistic regression analysis, serum cTnI and APACHE II score were independent predictor of death and length of stay in intensive care unit. Serum cTnI, APACHE II score, anion gap and serum lactate were independent predictor of need for inotropic/vasopressor support. Receiver-operating characteristics of serum cTnI as a predictor of death in septic shock were significant. The elevated serum level of cTnI correlated with the lower left ventricular ejection fraction (p<0.001). Conclusions: Myocardial injury can be determined in patients with septic shock by serum cTnI. Serum cTnI concentration correlates with myocardial dysfunction in septic shock. High serum cTnI predicts increased severity of sepsis and higher mortality. A close monitoring of patients with septic shock and elevated levels cTnI is warranted. [Copyright &y& Elsevier]

Background: The performance of point-of-care testing under controlled laboratory conditions may vary from results obtained in actual patient care settings. User errors are a major cause of this discrepancy. Methods: We studied the clinical performance of the Cardiac STATus (Spectral USA, Frederick, MD), a qualitative triple cardiac marker point-of-care test, under controlled laboratory conditions and in actual practice in an emergency department (ED) satellite laboratory. First-draw samples obtained from patients presenting to the hospital emergency department with chest pain were used for the study. Tests were performed in the chemistry research laboratory by a company product specialist or in an emergency department satellite laboratory by hospital staff. Test results were analyzed by correlation to the clinical discharge diagnosis. Results: In the emergency department, for the test system as a whole (any one or more marker(s) positive versus all three markers negative), sensitivity was 63%, specificity was 81%, positive predictive value was 26%, and negative predictive value was 95%. A manufacturer-supplied product specialist in a laboratory setting achieved very similar sensitivity, specificity, and positive and negative predictive values. Conclusions: The performance of this system under controlled laboratory conditions can be applied to estimate its performance at the point of care. [Copyright &y& Elsevier]

Patients admitted with suspicion of an acute coronary syndrome still constitute a diagnostic, prognostic and therapeutic challenge. In the vast majority of these patients the diagnosis is dependent on the results of measurements of cardiac markers. The troponins have a higher diagnostic sensitivity and specificity for detection of myocardial damage than previous markers and have also been proved to be valuable for early risk stratification. There is emerging evidence that these new cardiac markers might be used for selection of treatment in various forms of acute coronary syndromes. [ABSTRACT FROM AUTHOR]

Abstract: An ideal cardiac biochemical marker should have not only high sensitivity but also high specificity to myocardial infarction. The creatine kinase-MB, a relatively specific cardiac marker, could be elevated in situations other than acute myocardial infarction, such as renal failure, muscular injury, and myopathy. Although these are more specific than creatine kinase-MB, cardiac troponins have also been reported to be elevated in conditions other than acute myocardial infarction, such as chronic renal failure, acute myocarditis, cardiomyopathy, congestive heart failure, pulmonary embolism, rhabdomyolysis, sepsis, and left ventricular hypertrophy. With the ongoing research in this field, future holds hopes of finding an ideally specific marker of myocardial infarction, but until then biochemical markers should be used in conjunction with clinical assessment and electrocardiography in making the diagnosis of myocardial infarction, and the patients should not be treated merely on the basis of elevated serum levels of cardiac biochemical markers. [Copyright &y& Elsevier]