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Ischemic heart diseases (IHDs) remain a global health concern. Many IHD cases go undiagnosed due to challenges in the initial diagnostic process, particularly in cases of acute myocardial infarction (AMI). High-sensitivity cardiac troponin (hs-cTn) assays have revolutionized myocardial injury assessment, but variations in diagnostic cut-off values and population differences have raised challenges. This review addresses essential laboratory and clinical considerations for hs-cTn assays. Laboratory guidelines discuss the importance of establishing standardized 99th-percentile upper reference limits (URLs) considering factors such as age, sex, health status, and analytical precision. The reference population should exclude individuals with comorbidities like diabetes and renal disease, and rigorous selection is crucial. Some clinical guidelines emphasize the significance of sex-specific URL limits while others do not. They highlight the use of serial troponin assays for AMI diagnosis. In addition, timely reporting of accurate hs-cTn results is essential for effective clinical use. This review aims to provide a clearer understanding among laboratory professionals and clinicians on how to optimize the use of hs-cTn assays in clinical settings in order to ensure accurate AMI diagnosis and thus improve patient care and outcomes.

The aim of this article review is to analyze some models and clinical issues related to the implementation of accelerated diagnostic protocols based on specific cardiac biomarkers in patients admitted to the emergency department (ED) with symptoms compatible with acute cardiac disorders. Four specific clinical issues will be discussed in detail: (a) pathophysiological and clinical interpretations of circulating hs-cTnI and hs-cTnT levels; (b) the clinical relevance and estimation of the biological variation of biomarkers in patients admitted to the ED with acute and severe diseases; (c) the role and advantages of the point-of-care testing (POCT) methods for cardiac-specific biomarkers in pre-hospital and hospital clinical practice; and (d) the clinical role of specific cardiac biomarkers in patients with acute heart failure (AHF). In order to balance the risk between a hasty discharge versus the potential harms caused by a cardiac assessment in patients admitted to the ED with suspected acute cardiovascular disease, the measurement of specific cardiac biomarkers is essential for the early identification of the presence of myocardial dysfunction and/or injury and to significantly reduce the length and costs of hospitalization. Moreover, specific cardiac biomarkers (especially hs-cTnI and hs-cTnT) are useful predictors of mortality and major adverse cardiovascular events (MACE) in patients admitted to the ED with suspected acute cardiovascular disease. To guide the implementation of the most rapid algorithms for the diagnosis of Non-ST-Elevation Myocardial Infarction (NSTEMI) into routine clinical practice, clinical scientific societies and laboratory medicine societies should promote collaborative studies specifically designed for the evaluation of the analytical performance and, especially, the cost/benefit ratio resulting from the use of these clinical protocols and POCT methods in the ED clinical practice.

Currently, the symptomatic status and left ventricular ejection fraction (LVEF) play a crucial role in aortic stenosis (AS) assessment. However, the symptoms are often subjective, and LVEF is not a sensitive marker of left ventricle (LV) decompensation. Over the past years, the cardiac structure and function research on AS has increased due to advanced imaging modalities and potential therapies. New imaging parameters emerged as predictors of disease progression in AS. LV global longitudinal strain has proved useful for risk stratification in asymptomatic severe AS patients with preserved LVEF. The assessment of myocardial fibrosis by cardiac magnetic resonance is the most studied application and offers prognostic information on AS. Moreover, the usage of biomarkers in AS as objective measures of LV decompensation has recently gained more interest. The present review focuses on the transition from compensatory LV hypertrophy (H) to LV dysfunction and the biomarkers associated with myocardial wall stress, fibrosis, and myocyte death. Moreover, we discuss the potential impact of non-invasive imaging parameters for optimizing the timing of aortic valve replacement and provide insight into novel biomarkers for possible prognostic use in AS. However, data from randomized clinical trials are necessary to define their utility in daily practice.

BackgroundCardiac troponins and NT-proBNP are biomarkers of cardiac injury that are used clinically in the diagnosis of myocardial infarction and heart failure. It is not known whether the amount, types and patterns of physical activity (PA) and sedentary behaviour are associated with levels of cardiac biomarkers.MethodsIn the population-based Maastricht Study (n = 2,370, 51.3% male, 28.3% T2D) we determined cardiac biomarkers hs-cTnI, hs-cTnT, and NT-proBNP. PA and sedentary time were measured by activPAL and divided into quartiles [quartile 1 (Q1) served as reference]. The weekly pattern of moderate-to-vigorous PA (insufficiently active; regularly actives; weekend warriors) and coefficient of variation (CV) was calculated. Linear regression analyses were conducted with adjustment for demographic, lifestyle, and cardiovascular risk factors.ResultsThere was no consistent pattern between physical activity (different intensities: total, light, moderate-to-vigorous and vigorous) and sedentary time on the one hand and hs-cTnI and hs-cTnT on the other. Those with the highest levels of vigorous intensity PA had significantly lower levels of NT-proBNP. With regard to PA patterns, weekend warriors and regularly actives had lower levels of NT-proBNP but not with hs-cTnI and hs-cTnT (reference:insufficiently actives). A higher weekly moderate-to-vigorous PA CV (indicating more irregular activity) was associated with lower levels of hs-cTnI and higher levels of NT-proBNP, but not with hs-cTnT.ConclusionsIn general, there was no consistent association between PA and sedentary time and cardiac troponins. In contrast, vigorous and possibly moderate-to-vigorous intensity PA, especially if done regularly, were associated with lower levels of NT-proBNP.

• Little is known about the impact of sex-hormone therapy on hs-Tn in transgender patients. • Mean hs-Tn concentrations were similar in transgender women and transgender men, though analysis was limited by small sample size. • Further study on this vulnerable population underrepresented in troponin research is needed. Sex-differences in high sensitivity troponin (hs-Tn) concentrations are well established. There is, however, limited data to guide interpretation of hs-Tn in transgender patients, particularly those receiving gender-affirming hormone therapy. Our purpose was to evaluate troponin testing in transgender patients. Transgender adults attending a routine clinic visit provided demographic data, medical history, and venous blood samples. Patients with congestive heart failure or chronic kidney disease were excluded. hs-Tn was measured using the Architect Stat High Sensitivity Troponin-I (Abbott), Access 2 hsTnI (Beckman Coulter), and Elecsys Troponin T Gen 5 STAT (Roche) assays. hs-Tn below the limit of detection (LOD) is reported as the lower limit of detection (LLOD) Of 63 subjects, 76 % were transgender women. We found no significant difference in median hs-Tn concentrations or proportions of hs-Tn > LOD. In this cohort of stable transgender patients without CHF or CKD, we did not observe differences in hs-Tn concentrations between transgender women and transgender men. Meaningful conclusions are limited owing to inadequate sample size and population differences. Further research on hs-troponin concentrations in this underrepresented, vulnerable population is needed. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is the most frequently diagnosed cancer in women, causing over 500,000 deaths worldwide. Human epidermal growth factor receptor 2 is overexpressed in roughly 15–20% of the breast cancer cases diagnosed nowadays, denoting poor prognoses. However, the presence of this receptor in tumoral cells provided patients with the opportunity for treatment with HER2 inhibitors, which have well-documented clinical benefits but still present variable grades of cardiotoxicity. We evaluated 22 patients, diagnosed with HER2-positive breast cancer, who underwent combination treatment with trastuzumab, pertuzumab and docetaxel, and we monitored their cardiac profiles through radionuclide ventriculography and cardiac-biomarker measurements both at the beginning of their treatment and after 6 months of therapy. Our results confirmed the good cardiac safety profile of this therapeutic scheme while also suggesting use of radionuclide ventriculography and dosing of NT-proBNP and ST2-IL33R for early detection of cardiac impairment. (1) Background: The aim of our study was to determine whether monitoring cardiac function through RNV and cardiac biomarkers could predict the cardiac impact of combined therapy with trastuzumab, pertuzumab and docetaxel, which are regularly used nowadays to treat HER2-positive breast cancer. (2) Methods: This prospective monocentric study included 22 patients, diagnosed with HER2-positive breast cancer, who had their LVEFs and cardiac biomarkers evaluated both at the beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were collected to assess circulating cardiac biomarkers. RNV was performed in each patient after "in vivo" radiolabeling of the erythrocytes. The obtained results were then statistically correlated. (3) Results: The average LVEF decrease between the two time points was approximately 4%. Of the five biomarkers we considered in this paper, only NT-proBNP correlated with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = −0.615 for T0 and r = −0.751 for T1, respectively). ST2/IL-33R proved statistically significant at the T1 time point (r = −0.547). (4) Conclusions: A combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab and docetaxel. [ABSTRACT FROM AUTHOR]

The excessive intake and bioaccumulation of sodium fluoride (NaF) through water, toothpaste or pesticides could trigger cardiac oxidative stress. The effects of Hibiscus sabdariffa (HS) fractions on biochemical markers of the heart in NaF-induced rats. Thirty male and female rats were grouped into five: Normal control (NC) received water only, Sodium fluoride (NaF, 300 mg L−1), the others were exposed to 300 mg L−1 NaF while the treated animals received100 mg kg−1d−1 of aqueous, n-hexane and butanol -H. sabdariffa (AQE-HS, HEE-HS, BTE-HS) fractions orally for 14 days respectively. This study revealed that NaF exposure increases TBARS, TC, TG, LDL-c, AI, AC, CRI-I, CRI-II and arginase activity with a decrease in catalase, GST, SOD, GSH, HDL-c, and NO level whilethe HS treatment stimulates antioxidant production which eventually reduce oxidative stress. The AQE-HS suppressed TBARS, lipid profile, and cardiac indices. Therefore, bioactive constituent of HS attenuates NAF-induced cardiac oxidative stress. [ABSTRACT FROM AUTHOR]

The present study was designed to investigate the dynamics of right atrial pressure (RAP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) during physical exercise in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to determine whether these parameters might serve as a tool to measure exercise-dependent atrial stress as an indicator of right heart failure. This prospective observational cohort study included 100 CTEPH patients who underwent right heart catheterization during physical exercise (eRHC). Blood samples for MR-proANP measurement were taken prior, during, and after eRHC. MR-proANP levels were correlated to RAP levels at rest, at peak exercise (eRAP), and during recovery. RAP at rest ≤7 mmHg was defined as normal and eRAP >15 mmHg as suggestive of right heart failure. During eRHC mean RAP increased from 6 mmHg (standard deviation, SD 4) to 16 mmHg (SD 7; p < 0.001). MR-proANP levels and dynamics correlated with RAP at rest (r s = 0.61; p < 0.001) and at peak exercise (r s = 0.66; p < 0.001). Logistic regression analysis revealed the peak MR-proANP level (B = 0.058; p = 0.004) and the right atrial area (B = 0.389; p < 0.001) to be associated with eRAP dynamics. A peak MR-proANP level ≥139 pmol/L (AUC = 0.81) and recovery level ≥159 pmol/L (AUC = 0.82) predicted an eRAP >15 mmHg. Physical exercise unmasked right heart failure in 39% of patients with normal RAP at rest; these patients were also characterized by a more distinct increase in MR-proANP levels (p = 0.005) and higher peak (p < 0.001) and recovery levels (p < 0.001). RAP and MR-proANP dynamics unmask manifest and latent right heart failure in CTEPH patients. [ABSTRACT FROM AUTHOR]

We have previously surveyed a panel of 508 physicians from around the world about which biomarkers would be relevant if obtained in a very short time frame, corresponding to emergency situations (life-threatening or not). The biomarkers that emerged from this study were markers of cardiovascular disease: troponin, D-dimers, and brain natriuretic peptide (BNP). Cardiovascular disease is a group of disorders affecting the heart and blood vessels. At the intersection of medicine, basic research and engineering, biosensors that address the need for rapid biological analysis could find a place of choice in the hospital or primary care ecosystem. Rapid, reliable, and inexpensive analysis with a multi-marker approach, including machine learning analysis for patient risk analysis, could meet the demand of medical teams. The objective of this opinion review, proposed by a multidisciplinary team of experts (physicians, biologists, market access experts, and engineers), is to present cases where a rapid biological response is indeed valuable, to provide a short overview of current biosensor technologies for cardiac biomarkers designed for a short result time, and to discuss existing market access issues. [ABSTRACT FROM AUTHOR]

Many studies conducted after the pandemic period revealed that, while COVID-19 primarily injured the lungs, it also affects other organs in the form of cardiovascular complications, metabolic derangements, renal damage, and so on. Although we know that inflammatory cascades, complement activation, and pro-inflammatory cytokines are all involved in vasculitic processes that cause organ damage, we do not know the exact mechanism of complications such as acute respiratory distress syndrome (ARDS), cardiovascular ischemia, deep vein thrombosis, pulmonary thromboembolism, and brain injuries (embolism) that are frequently observed in COVID 19. The currently available biomarkers do not predict the severity of the aforementioned complications. As a result, more specific biomarkers such as serum calcium binding protein (S100B), glial fibrillary acid protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), hs-TNI, (highly sensitive cardiac troponin) – HBDH, (Hydroxybutyrate Dehydrogenase), CK-MB (creatine kinase myocardial band), ST2 (suppression of tumorigenicity 2) are in need for early detection & improved clinical outcome. [ABSTRACT FROM AUTHOR]

Background: It remains unclear whether elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) can serve as a "risk equivalent" for cardiovascular disease to adults at high cardiovascular risk.Methods: We included 9789 participants (mean age 63.2 years, 55% women, 19.4% Black, 13% with a history of cardiovascular disease) who attended Atherosclerosis Risk in Communities Study Visit 4 (1996-1998). We classified participants as having a history of cardiovascular disease at baseline and, among those without cardiovascular disease, we defined categories of NT-proBNP (<125, 125-449, ≥450 pg/mL). We used Cox regression to estimate associations of NT-proBNP with incident cardiovascular disease and mortality.Results: Over a median 20.5 years of follow-up, there were 4562 deaths (917 cardiovascular deaths). There were 2817 first events and 806 recurrent events (in those with a history of cardiovascular disease at baseline). Among individuals without a history of cardiovascular disease, those adults with NT-proBNP ≥450 pg/mL had significantly higher risks of all-cause death (hazard ratio [HR] 2.12; 95% confidence interval [CI], 1.78-2.53), cardiovascular mortality (HR 2.92; 95% CI, 2.15-3.97), incident total cardiovascular disease (HR 2.59; 95% CI, 2.13-3.16), atherosclerotic cardiovascular disease (HR 2.20; 95% CI, 1.72-2.80), and heart failure (HR 3.81; 95% CI, 3.01-4.81), compared with individuals with NT-proBNP <125 pg/mL. The elevated cardiovascular risk in persons with high NT-proBNP and no history of cardiovascular disease was similar to, or higher than, the risk conferred by a history of cardiovascular disease.Conclusions: Our findings suggest that it might be appropriate to manage adults with NT-proBNP ≥450 pg/mL as if they had a history of clinical cardiovascular disease. [ABSTRACT FROM AUTHOR]

Perioperative acute myocardial infarction (AMI) after noncardiac surgery increases the mortality rate of patients who experience it. Depending on the definition of AMI used and the patient population studied, perioperative AMI occurs in 0.01% to 10% of patients. Most instances of perioperative AMI occur within the first two days after surgery, do not present with classic myocardial infarction symptoms, and are the result of myocardial oxygen supply versus oxygen demand mismatch. Older patients; those with preexisting cardiovascular conditions; those undergoing thoracic, upper abdominal, or major vascular procedures; and those who experience perioperative hemodynamic instability are at particular risk. This article provides a clinically based review of the pathophysiology, perioperative risks, treatment options, outcomes, and nursing implications of perioperative AMI and ischemia. It provides evidence to assist perioperative nurses with meeting the physiologic and safety needs of their patients and highlights the evolving scientific understanding and clinical guidelines to promote current practice. [ABSTRACT FROM AUTHOR]

Post-exercise elevations of cardiac troponin T (cTnT) and I (cTnI) are often used in isolation but interpreted interchangeably. Research suggests, however, that post-exercise cTn kinetic might differ with each isoform. In this cross-sectional observational study, we collected blood samples before, immediately after (5 minutes), and at 1-, 3-, 6-, 12-, and 24-hour post-exercise in a mixed cohort of 56 participants after a distance-trial of 60 min continuous swimming (age range from 14 to 22, 57.1% female). Cardiac troponin kinetics were modelled using Bayesian mixed-effects models to estimate time to peak (TTP) and peak concentration (PC) for each isoform, while controlling for participants sex, tanner stage and average relative heart rate during the test. Exercise induced an elevation of cTnT and cTnI in 93% and 75% of the participants, respectively. Cardiac troponin T peaked earlier, at 2.9 h (CI: 2.6 – 3.2 h) post-exercise, whereas cTnI peaked later, at 4.5 h (CI: 4.2 – 4.9 h). Peak concentrations for cTnT and cTnI were 2.5 ng/L, CI: 0 – 11.2 ng/L and 2.16 ng/L, CI: 0 – 22.7 ng/L, respectively. Additionally, we did not observe a systematic effect of sex and maturational status mediating cTn responses. [ABSTRACT FROM AUTHOR]

Thanat Tangpaisarn,1 Nirut Srimakam,1 Vichai Senthong,2 Pariwat Phungoen,1 Praew Kotruchin1 1Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Internal Medicine, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Praew KotruchinDepartment of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, Tel +66 65 5269 422, Email kpraew@kku.ac.thBackground: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients.Methods: This was a retrospective cohort study. Patients aged ≥ 18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported.Results: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10– 6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27– 10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01– 1.06), male sex (OR = 2.15; 95% CI 1.09– 4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20– 8.10) were associated with significant coronary stenosis.Conclusion: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.Keywords: renal dysfunction, cardiac biomarkers, troponin, acute coronary syndromes, Asian

With a global towering prevalence of index acute myocardial infarction (nonrecurrent MI, NR-MI), a high incidence of recurrent MI (R-MI) has emerged in recent decades. Despite the extensive occurrence, the promising predictors of R-MI have been elusive within the cohort of survivors. This study investigates and validates the involvement of distinct gene expressions in R-MI and NR-MI. Bioinformatics tools were used to identify DEGs from the GEO dataset, functional annotation, pathway enrichment analysis, and the PPI network analysis to find hub genes. The validation of proposed genes was conceded by qRT-PCR and Western Blot analysis in experimentally induced NR-MI and R-MI models on a temporal basis. The temporal findings based on RT-PCR consequences reveal a significant and constant upregulation of the UBE2N in the NR-MI model out of the proposed three DEGs (UBE2N, UBB, and TMEM189), while no expression was reported in the R-MI model. Additionally, the proteomics study proposed five DEGs (IL2RB, NKG7, GZMH, CXCR6, and GZMK) for the R-MI model since IL2RB was spotted for significant and persistent downregulation with different time points. Further, Western Blot analysis validated these target genes' expressions temporally. I/R-induced NR-MI and R-MI models were confirmed by the biochemical parameters (CKMB, LDH, cTnI, serum nitrite/nitrate concentration, and inflammatory cytokines) and histological assessments of myocardial tissue. These results underscore the importance of understanding genetic mechanisms underlying MI and highlight the potential of UBE2N and IL2RB as biomarkers for non-recurrent and recurrent MI, respectively. [Display omitted] • Integrate bioinformatic tools to explore biomarkers in non-recurring/recurring MI. • Confirms findings via qRT-PCR and Western Blot analysis, ensuring reliability. • Examines temporal gene expression patterns in experimentally induced MI models. • Supplements gene analysis with proteomics data confirms the involved biomarkers. • Genetic marker validation in endorsed MI models highlights translational potential. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the most prevalent and primary cause of death globally, and the most deadly and dangerous of these diseases is myocardial infarction (MI), commonly known as heart attack, which develops due to insufficient coronary artery flow and causes irreversible myocardial cell damage. This study aimed to investigate the cardioprotective effects of Momordica charantia (MC), known for its antioxidant and anti-inflammatory properties, in an experimental acute MI model induced by isoprenaline (ISO) in rats. In the study, forty-nine male Wistar rats were split up into 7 groups as control (CONT), Glycerin (GLCN), isoprenaline (ISO), 500 mg/kg MC (MC500), isoprenaline+100 mg/kg MC (ISO+MC100), isoprenaline+250 mg/kg MC (ISO+MC250), isoprenaline+500 mg/kg MC (ISO+MC500). Substances were administered to the groups for 30 days. Isoprenaline (85 mg/kg) was administered by subcutaneous injection on the last two days of the study (days of the 29 and 30). Electrocardiogram (ECG) recording and collecting blood samples of the animals were performed 24 hours after the last administration of the substances under the anesthesia. Serum IL-6, Nrf2, IL-10, HO-1, TNF-α, CK-MB, cTn-I and CRP levels were determined by the ELISA method. Compared to the ISO group, levels of CK-MB, HO-1, TNF-α, CRP, IL-6 and cTn-I were found statistically lower in MC -administered groups (p<0.05). In addition, MC restored ISO-induced abnormal ECG changes to normal levels. In conclusion, ECG findings, proinflammatory, anti-inflammatory, antioxidative and cardiac biomarkers suggest that MC may have cardioprotective properties. [Display omitted] • MC increased antioxidant enzymes and decreased biomarker of oxidative stress. • MC reduced levels of inflammatory markers such as TNF-α, IL-6 and CRP. • MC decreased the serum levels of cardiac biomarkers such as CK-MB and cTn-I. • MC corrects heart rate, T-wave, ST-segment and R-wave abnormalities caused by ISO. [ABSTRACT FROM AUTHOR]

Phospholipase C (PLC) enzymes represent crucial participants in the plasma membrane of mammalian cells, including the cardiac sarcolemmal (SL) membrane of cardiomyocytes. They are responsible for the hydrolysis of phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P2) into 1,2-diacylglycerol (DAG) and inositol (1,4,5) trisphosphate (Ins(1,4,5)P3), both essential lipid mediators. These second messengers regulate the intracellular calcium (Ca2+) concentration, which activates signal transduction cascades involved in the regulation of cardiomyocyte activity. Of note, emerging evidence suggests that changes in cardiomyocytes’ phospholipid profiles are associated with an increased occurrence of cardiovascular diseases, but the underlying mechanisms are still poorly understood. This review aims to provide a comprehensive overview of the significant impact of PLC on the cardiovascular system, encompassing both physiological and pathological conditions. Specifically, it focuses on the relevance of PLCβ isoforms as potential cardiac biomarkers, due to their implications for pathological disorders, such as cardiac hypertrophy, diabetic cardiomyopathy, and myocardial ischemia/reperfusion injury. Gaining a deeper understanding of the mechanisms underlying PLCβ activation and regulation is crucial for unraveling the complex signaling networks involved in healthy and diseased myocardium. Ultimately, this knowledge holds significant promise for advancing the development of potential therapeutic strategies that can effectively target and address cardiac disorders by focusing on the PLCβ subfamily.

Introduction: Acute Myocardial Infarction (AMI) is a serious life threatening condition having a high mortality and morbidity rate. Hence, early detection and appropriate treatment is essential. Clinically Troponin I and Creatinine Kinase Myocardial Band (CK-MB) are currently used to detect AMI. But its rise in blood concentrations is seen only after 4-6 hours after the onset of AMI. Clinical research shows that Heart-type Fatty Acid Binding Protein (H-FABP), a novel biomarker, is beneficial in the early detection of AMI. Aim: To determine the diagnostic accuracy of H-FABP and compare with the existing blood biochemical markers, such as Troponin I and CK-MB, in the early detection of AMI in south Indian population. Materials and Methods: This cross-sectional study was conducted in Sree Balaji Medical College and Hospital, south Chennai, Tamil Nadu, India, from March 2017 to April 2019. A total of 50 participants, aged between 40-75 years, and diagnosed with ST elevation myocardial infarction presenting within 24 hours to the emergency room were included. Serum was collected during the time of admission (0 hour), between 4-6 hours from the time of admission and between 12-24 hours from the time of admission for estimation of cardiac specific biomarkers such as cardiac troponin I, H-FABP, CK-MB. The sensitivity, specificity and accuracy of the cardiac-specific biomarkers were calculated using Receiving Operating Characteristics (ROC) curve analysis. Results: There were 38 males and 12 females, with a mean age of 62.1±4.7 years. The sensitivity of H-FABP at the time of admission (0 hour) was 88%, 78% between 4-6 hours of admission, and 42% between 12-24 hours of admission. At 0 hour, the sensitivity of H-FABP (88%) was high compared to cardiac troponin I (43%) and CK-MB (40%). The accuracy of H-FABP and cTnI was equal (80% each) at the time of admission. At 4-6 hours after admission, cardiac troponin I showed higher sensitivity, specificity and accuracy compared to H-FABP. ROC analysis showed the Area Under the Curve (AUC) for H-FABP was higher (0.81) compared to cardiac troponin I and CK-MB. Conclusion: H-FABP was found to be more sensitive compared to cardiac troponin I or CK-MB in AMI patients. Hence, early diagnosis of AMI is made possible with the H-FABP measurements.

BackgroundAn analysis of cardiac injury markers in patients with OSA who sustain an episode of acute coronary syndrome (ACS) may contribute to a better understanding of the interactions and impact of OSA in subjects with ACS. We compared peak cardiac troponin I (cTnI) levels in patients with OSA and patients without OSA who were admitted for ACS.MethodsBlood samples were collected every 6 hours from the time of admission until two consecutive assays showed a downward trend in the cTnI assay. The highest value obtained defined the peak cTnI value, which provides an estimate of infarct size.ResultsWe included 89 patients with OSA and 38 patients without OSA with an apnea-hypopnea index of a median of 32 (interquartile range [IQR], 20.8-46.6/h and 4.8 [IQR, 1.6-9.6]/h, respectively. The peak cTnI value was significantly higher in patients without OSA than in patients with OSA (median, 10.7 ng/mL [IQR, 1.78-40.1 ng/mL] vs 3.79 ng/mL [IQR, 0.37-24.3 ng/mL]; P = .04). The multivariable linear regression analysis of the relationship between peak cTnI value and patient group, age, sex, and type of ACS showed that the presence or absence of OSA significantly contributed to the peak cTnI level, which was 54% lower in patients with OSA than in those without OSA.ConclusionsThe results of this study suggest that OSA has a protective effect in the context of myocardial infarction and that patients with OSA may experience less severe myocardial injury. The possible role of OSA in cardioprotection should be explored in future studies.

BackgroundRegression of left ventricular hypertrophy (LVH) is feasible with more frequent hemodialysis (HD). We aimed to ascertain pathways associated with regression of left ventricular mass (LVM) in patients enrolled in the Frequent HD Network (FHN) trials.MethodsThis was a post hoc observational cohort study. We hypothesized LVH regression with frequent HD was associated with a different cardiovascular biomarker profile. Regressors were defined as patients who achieved a reduction of more than 10% in LVM at 12 months. Progressors were defined as patients who had a minimum of 10% increase in LVM at 12 months.ResultsAmong 332 randomized patients, 243 had biomarker data available. Of these, 121 patients did not progress or regress, 77 were regressors, and 45 were progressors. Mean LVM change differed between regressors and progressors by -65.6 (-74.0 to -57.2) g, p < 0.001. Regressors had a median (interquartile range) increase in dialysis frequency (from 3.0 [3.0-3.0] to 4.9 [3-5.7] per week, p = 0.001) and reductions in pre-dialysis systolic (from 149.0 [136.0-162.0] to 136.0 [123.0-152.0] mm Hg, p < 0.001) and diastolic (from 83.0 [71.0-91.0] to 76.0 [68.0-84.0] mm Hg, p < 0.001) blood pressures. Klotho levels increased in regressors versus progressors (76.9 [10.5-143.3] pg/mL, p = 0.024). Tissue inhibitors of metalloproteinase (TIMP)-2 levels fell in regressors compared to progressors (-7,853 [-14,653 to -1,052] pg/mL, p = 0.024). TIMP-1 and log (brain natriuretic -peptide [BNP]) levels also tended to fall in regressors. Changes in LVM correlated inversely with changes in klotho (r = -0.24, p = 0.014). -Conclusions: Markers of collagen turnover and changes in klotho levels are potential novel pathways associated with regression of LVH in the dialysis population, which will require further prospective validation.

Abstract Aims To explore the correlation between cardiac‐related comorbidities, cardiac biomarkers, acute myocardial injury, and severity level, outcomes in COVID‐19 patients. Method Pubmed, Web of Science, Embase, CNKI, VIP, Wanfang, Cochrane Library databases, medRxiv, and Sinomed were reviewed systemically. Various types of clinical research reporting cardiac‐related comorbidities, cardiac biomarkers including lactate dehydrogenase (LDH), troponin I (TnI), high sensitivity troponin I (hs‐TnI), creatine kinase (CK), creatine kinase–MB (CK‐MB), myoglobin (Myo), N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) and acute cardiac injury grouped by severity of COVID‐19 were included. Outcome measures were events and total sample size for comorbidities, acute cardiac injury, and laboratory parameters of these biomarkers. The study was performed with Stata version 15.1. Results Seventy studies, with a total of 15,354 cases were identified. The results showed that COVID‐19's severity was related to cardiovascular disease. Similar odds ratios (ORs) were achieved in hypertension except for severe versus critical group (OR = 1.406; 95% CI, 0.942–2.097; p = .095). The relative risk (RR) of acute cardiac injury is 7.01 (95% CI, 5.64–8.71) in non‐survivor cases. When compared with the different severity of cardiac biomarkers, the pool OR of CK, CK‐MB, TnI, Myo and LDH were 2.683 (95% CI, 0.83–8.671; p = .106; I2 = 0%), 2.263 (95% CI, 0.939–5.457; p = .069), 1.242 (95% CI, 0.628–2.457; p = .534), 1.756 (95% CI, 0.608–5.071; p = .298; I2 = 42.3%), 1.387 (95% CI, 0.707–2.721; p = .341; I2 = 0%) in the critical versus severe group, whose trends were not similar to other groups. The standard mean differences (SMD) of CK and TnI in the critical versus severe group were 0.09 (95% CI, −0.33 to 0.50; p = .685; I2 = 65.2%), 0.478 (95% CI, −0.183 to 1.138; p = .156; I2 = 76.7%), which means no difference was observed in the serum level of these indicators. Conclusion Most of the findings clearly indicate that hypertension, cardiovascular disease, acute cardiac injury, and related laboratory indicators are associated with the severity of COVID‐19. What is now needed are cross‐national prospectively designed observational or clinical trials that will help improve the certainty of the available evidence and treatment decisions for patients.

IntroductionCardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers.MethodsTherefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%.ResultsThe majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04–3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16–23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41–13.39) and ARDS (OR = 6.65, 95% CI = 4.04–8.91).ConclusionCardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.

Coronavirus disease 19 (COVID-19) is caused by viral infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Where upregulation of several important biomarkers and multiple organ dysfunction occurs, this study aimed to evaluate the association of cardiac biomarkers and CS induced acute lung damage with disease severity and mortality in survival of COVID-19 patients. A total of 500 COVID-19 patients with elevated cardiac biomarkers were studied for the analysis of myocardial abnormality through cardiac enzymes, inflammatory biomarkers, and the expression analysis of various cytokines, including IL-1, IL-6, IL-10, IL-17, and IL-25 genes. The elevation of various cardiac enzymes including LDH (87%), CK (78.4%), TNI (80.4%), CK-MB (83%), and D-dimer (80.8%) were found correlated (p < 0.001) with COVID-19 infection. Cardiac enzyme elevation was highly associated with an increased level of inflammatory biomarkers such as CRP (14.2%), SAA (11.4%) and erythrocyte sedimentation rate (ESR) (7.8%) (p = 0.001 for all). The quantitative expression analysis of IL-10, 1L-17, and 1L-25 were found to be high, while those of IL-1 and IL-6 were moderately elevated. The death-to-live ratio of COVID-19 patients was 457:43 indicating that the patients having elevated levels of both CKMB, D-dimer, CK and IL-1, IL-6, IL-10 and D-dimer, Troponin, CK and IL-1, IL-10 had high fatality rate (73% and 12% respectively). The current finding concludes that the evaluation of cardiac biomarkers with cytokine storm plays a significant role in COVID-19-associated anatomical organ damage, myocardial injury, and mortality. Physicians should pay special attention to cardiac biomarkers in patients with old age, inflammation, and comorbidities among COVID-19 infections. [ABSTRACT FROM AUTHOR]

By providing a facile and scalable alternative to otherwise complex and resource-intensive synthesis of graphene, laser-induced graphene (LIG) is spearheading the translation of graphene-based propositions to deployable technologies for societal benefit. LIG is a versatile and economical synthesis approach which is being used on a variety of substrates and in a multitude of applicationsâ€"including miniaturized sensing systems. One aspect that has not been addressed thoroughly in LIG-based miniaturized sensing systems is its successful integration with microfluidics and its possible use in point-of-care settings. To further diversify the applications of LIG with integrated microfluidics, this work reports on the development of an integrated flexible microfluidics-LIG based electrochemical biosensor. The work describes the methodology to develop a polydimethylsiloxane-LIG scribed polyamide microfluidic device in a leakage-free flexible application. In view of the excellent electrical and electrochemical properties of LIG, such device has been employed for electrochemical biosensing. The biosensing capabilities of the microfluidic device were validated via sensing of cardiac troponin Iâ€"a gold standard cardiac biomarker for early identification of acute myocardial infarction (AMI). The developed biosensor demonstrated a detection and quantification limit of 45.33 pg mlâˆ'1 and 151.10 pg mlâˆ'1 respectively, which are in clinically significant ranges for diagnosis of AMI. The µ -fluidic biosensor was also analyzed for stability and interference with other cardiac biomarkers. The developed integrated µ -fluidic electrochemical biosensor was evaluated for possible point-of-source applications in conjunction with a custom 3D printed peristaltic pump and smartphone-enabled miniaturized potentiostat. [ABSTRACT FROM AUTHOR]

Melatonin has emerged as an anti-inflammatory agent, potent direct free-radical scavenger, and an indirect antioxidant in preventing ischemia-reperfusion injury. This study aimed to evaluate melatonin's effect on cardiac biomarkers after coronary artery bypass grafting (CABG). A double-blind, randomized placebo-controlled pilot clinical study. Booali Sina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. One hundred patients undergoing elective CABG. The patients were divided randomly into control (C) and melatonin (M) groups (50 patients per group). The M group received 3 mg of melatonin the night before surgery, 3 mg in the morning, and routine cardiac surgery medications. The C group received 1 placebo tablet rather than melatonin. After surgery, the patients in the M group received 3 mg of melatonin, and the C group received 1 placebo tablet at bedtime until the third day after CABG. In both groups, creatine kinase-MB (CPK-MB), cardiac troponin I, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before surgery and on the first, second, and third postoperative days. Serum CPK-MB levels on the second and third day after CABG were significantly lower in the M group than in the C group (p < 0.05). Regarding cardiac troponin I, CRP, and ESR markers, there were no significant changes in serum concentration before surgery and on the first, second, and third days after surgery between the 2 groups (p > 0.05). The mean length of hospitalization in the ICU was lower in the M group (3.4 ± 1.05) compared with the C group (3.96 ± 1.06, p = 0.01). Melatonin reduced the postoperative level of CPK-MB and the length of hospitalization in the ICU in patients who underwent cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Given the expansion of noninvasive diagnosis with 99mTc-pyrophosphate (99mTc-PYP) scanning, and clinical use of the transthyretin stabilizer, tafamidis, we sought to examine the interplay of planar imaging heart-to-contralateral lung (H/CL) ratio, cardiac biomarkers, and survival probability in a contemporary cohort of patients referred for noninvasive evaluation of ATTR-CM.Methods: This single-center retrospective cohort study included 351 consecutive patients who underwent a standardized imaging protocol with 99mTc-PYP scanning for the evaluation of ATTR-CM from January 1, 2018, to January 1, 2020. After the exclusion of light chain amyloidosis, patients were characterized as scan consistent with ATTR (+ATTR-CM) or scan not consistent with ATTR (-ATTR-CM) using current guidelines. Linear regression was used to examine the relationship between biomarkers and H/CL and univariate Cox proportional hazards models were used to assess the probability of transplant-free survival.Results: We included 318 patients in the analysis (n = 86 patients +ATTR-CM; n = 232 patients -ATTR-CM). The median follow-up time was 20.1 months. During the study period, 67% of +ATTR-CM patients received tafamidis (median treatment duration, 17 months). The median H/CL ratio was 1.58 (interquartile range, 1.40-1.75). An H/CL ratio of more than 1.6 or less than 1.6 did not seem to have an impact on survival probability in +ATTR-CM patients (P = .30; hazard ratio, 0.65; 95% confidence interval, 0.31-1.41). Cardiac biomarkers were poorly correlated with H/CL (troponin T, R2 = 0.024; N-terminal pro-B-type natriuretic peptide, R2 =0.023). The Gillmore staging system predicted survival probability in +ATTR-CM as well as in the entire cohort referred for scanning. There was a trend toward longer survival among those who were -ATTR-CM compared with +ATTR-CM (P = .051; hazard ratio, 0.64; 95% confidence interval, 0.40-1.00).Conclusions: At a large referral center, the intensity of 99mTc-PYP uptake (H/CL ratio) has neither correlation with cardiac biomarker concentrations nor prognostic usefulness in an analysis of intermediate term outcomes in the early therapeutics era. The H/CL ratio has diagnostic value, but offers little prognostic value in patients with ATTR-CM. Established staging schema were predictive of survival in this contemporary cohort, re-emphasizing the importance of cardiac biomarkers and renal function in assessing disease severity and prognosis. [ABSTRACT FROM AUTHOR]

Background: In people, the cardiovascular effects of obesity include systemic hypertension, cardiac remodelling and both systolic and diastolic dysfunction, whilst weight reduction can reverse myocardial remodelling and reduce risk of subsequent cardiovascular disease. To date, variable results are reported in studies of the effect of obesity and controlled weight reduction on cardiovascular morphology and function in dogs. This prospective study aimed to assess cardiac function, heart rate variability, cardiac biomarkers and body composition before and after weight reduction in pet dogs with obesity. Twenty-four client-owned dogs referred for weight management due to obesity were recruited. To assess the cardiac effects of obesity, body composition analysis (by dual energy X-ray absorptiometry, DEXA) and cardiovascular assessment (echocardiography, Doppler blood pressure, electrocardiography, cardiac biomarkers) were performed prior to weight management. Twelve dogs completed the study and reached target weight, receiving a further cardiovascular assessment and DEXA. A Wilcoxon-signed rank test was used to compare each variable pre- and post- weight reduction. Results: Median (interquartile range) duration of weight loss was 224 days (124–245 days), percentage weight loss was 23% (18–31%) of starting weight. Median change in body fat mass was -50% (-44% to -55%; P = 0.004), whilst median change in lean mass was -7% (+ 1% to -18%, P = 0.083). Before weight reduction, diastolic dysfunction (evidence of impaired relaxation in all dogs), increased left ventricular wall thickness and mildly elevated systolic blood pressure (14/24 ≥ 160 mmHg, median 165 mmHg (140–183)) were common features in dogs with obesity. However, systolic left ventricular wall dimensions were the only variables that changed after weight reduction, with a decrease in both the systolic interventricular septum (P = 0.029) and systolic left ventricular free wall (P = 0.017). There was no evidence of decreased heart rate variability in dogs with obesity (P = 0.367), and no change in cardiac biomarker concentrations with weight reduction (N-terminal proBNP, P = 0.262; cardiac troponin I P = 0.657). Conclusions: Canine obesity results in diastolic dysfunction and left ventricular hypertrophy, the latter of which improves with significant weight and fat mass reduction. Further studies are required to clarify the clinical consequences of these findings. [ABSTRACT FROM AUTHOR]

Background: The combination of acute myocardial infarction (AMI) and atrial fibrillation (AF) is still a thorny problem in the clinic. At present, there are few reports on the role of soluble suppression of tumorigenicity 2 (sST2) in AF after AMI. This study was to explore the predictive value of sST2 in patients with AMI for new-onset AF. Methods: This is a single-center retrospective clinical observation study. We continuously included AMI patients from September 2019 to November 2021. The concentration of sST2 in blood samples was determined. During admission, a suspicious heart rhythm was recorded by electrocardiogram (ECG) monitoring, and new-onset AF was confirmed by immediate body surface ECG. Results: After multiple factors were included, age, right coronary artery, high-sensitivity C-reactive protein, left ventricular ejection fraction, and sST2 were still risk factors for new-onset AF. The area under curve value of age and sST2 was more than 0.7, which showed good diagnostic value. For reevaluation, the sST2 was added to the clinical new-onset AF prediction model. It was found that the integrated discrimination improvement and net reclassification index in the model were improved significantly. Conclusion: sST2 is an independent predictor of new-onset AF in patients with AMI and can improve the accuracy of the AF risk model. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Several studies have investigated the association between cardiac biomarkers and short-term prognosis in the COVID-19 infection. However, the data on the predictive value of cardiac biomarkers to predict long-term prognosis in COVID-19 infection are limited. We aimed at determining the relationship between N-terminal brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-TnI) as cardiac biomarkers and in-hospital/ long-term outcomes in COVID-19 infection. PATIENTS AND METHODS: The study included a total of 916 patients with confirmed COVID-19 infection. The primary outcome was in-hospital and 1-year mortality. The secondary outcome was intensive care need at admission or the need to be transferred to the intensive care unit later on. RESULTS: The study included 498 (54.4%) males and 418 (45.6%) females with a mean age of 55.1±18.5 years. The patients with known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), chronic kidney disease (CKD), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS score (≥ 4), lower EF, higher hs-TnI, and NT-proBNP levels had increased in-hospital and 1-year mortality. After multivariate analysis, NT-proBNP, hs-TnI, CKD, ARF, diabetes mellitus, and CAD were independent predictors of in-hospital and 1-year mortality. After ROC analysis, NT-proBNP cut-off levels of 1022.50 (sensitivity 87.5%, specificity 87.1%) and 1008 (sensitivity 88.6%, specificity 88.0%) were found to predict in-hospital and 1-year mortality, respectively. Hs-TnI cut-off levels of 49.6 (sensitivity 88.6%, specificity 88.9%) and 34.10 (sensitivity 83.8%, specificity 84.1%) were found to predict in-hospital and 1-year mortality, respectively. CONCLUSIONS: The current study suggests that NT-proBNP and hs-TnI can be used as valuable cardiac biomarkers to predict short-term and long-term parameters in COVID-19 infection. [ABSTRACT FROM AUTHOR]

Ischemic heart disease (IHD) constitutes the leading global cause of mortality and morbidity. Although significant progress has been achieved in the diagnosis, treatment, and prognosis of IHD, more robust diagnostic biomarkers and therapeutic interventions are still needed to circumvent the increasing incidence of IHD. MicroRNAs (miRNAs) are critical regulators of cardiovascular function and are involved in various facets of cardiovascular biology. While the knowledge of the role of miRNAs in IHD as diagnostic biomarkers has improved, research emphasis on how miRNAs can be effectively used for diagnosis and prognosis of IHD is crucial. This review provides an overview of the biology, therapeutic and diagnostic potential, as well as the caveats of using miRNAs in IHD based on existing research. [ABSTRACT FROM AUTHOR]

Purpose: Severe trauma can lead to end organ damages of varying severity, including myocardial injury. In the non-cardiac surgery setting, there is extensive evidence that perioperative myocardial injury is associated with increased morbidity and mortality. The impact of myocardial injury on outcome after severe trauma has not been investigated adequately yet. We hypothesized that myocardial injury is associated with increased in-hospital mortality in patients with severe trauma. Materials/methods: This retrospective cohort study included patients ≥ 18 years with severe trauma [defined as injury severity score (ISS) ≥ 16] that were admitted to the resuscitation room of the Emergency Department of the University Hospital Duesseldorf, Germany, between 2016 and 2019. The main endpoint was in-hospital mortality. Main exposure was myocardial injury at arrival [defined as high-sensitive troponin T (hsTnT) > 14 ng/l]. For statistical analysis, receiver operating characteristic curve (ROC) and multivariate binary logistic regression were performed. Results: Out of 368 patients, 353 were included into statistical analysis (72.5% male, age: 55 ± 21, ISS: 28 ± 12). Overall in-hospital mortality was 26.1%. Myocardial injury at presentation was detected in 149 (42.2%) patients. In-hospital mortality of patients with and without myocardial injury at presentation was 45% versus 12.3%, respectively. The area under the curve (AUC) for hsTnT and mortality was 0.76 [95% confidence interval (CI) 0.71–0.82]. The adjusted odds ratio of myocardial injury for in-hospital mortality was 2.27 ([95%CI 1.16–4.45]; p = 0.017). Conclusion: Myocardial injury after severe trauma is common and independently associated with in-hospital mortality. Thus, hsTnT might serve as a new prognostic marker in this cohort. [ABSTRACT FROM AUTHOR]

Doxorubicin (DOX) is a powerful antitumor agent with a well-known cardiaotoxic side effects. In the current study, the ameliorative combined impacts of montelukast (Mont) and Klotho against doxorubicin-induced cardiac toxicity were examined. Fifty-six adult male rats (2 months age and weighting 150–200 g) were grouped into 7 groups (8 rats per group). Animals received doxorubicin alone or in combination with either Mont or Klotho. After 2 weeks of treatments, serum samples were examined to assess the changes in cardiac activity biomarkers such as LDH, CK-MB, cardiac troponin-I (cTn-I), and heart fatty acid binding protein (H-FABP). Serum changes of IL-6, inducible nitric oxide synthase (iNOS), and caspase-3 levels were assayed. The oxidative stress biomarkers such as total antioxidant capacity (TAC) and inflammatory (rat IL-1β and rat TNF-α,) and anti-inflammatory (rat IL-10) cytokines were examined. Heart histology and transforming growth factor-β1 (TGF-β1) immunoreactivity were measured. DOX induced cardiomyopathy, which was reflected by the increases in all examined cardiac parameters. Real-time PCR confirmed that DOX upregulated the expression of TNF-α and IL-1β and decreased the expression of IL-10. Moreover, DOX showed marked elevation in the ST segment T wave complex, causing profound tachycardia. Heart histology assessments showed cardiac cell necrosis, inflammatory cell infiltration, interstitial congestion, and increased TGF-β1 immunoreactivity. Montelukast and Klotho administration ameliorated all the altered parameters when administered alone or in combination to DOX-intoxicated rats. Klotho was more effective compared with montelukast in terms of reductions in heart rate, ST segment T wave complex elevation, cardiac enzymes (lactate dehydrogenase; LDH, creatine kinase-MB; CK-MB, cardiac troponin I; cTn-I, heart fatty acid binding protein; H-FABP) cardiac histology, and caspase-3 levels and increases in TAC activity. Montelukast was more effective in reducing serum levels of IL6 and iNOS, expression of TNF-α and IL-1β, and the upregulation of IL-10 expression. The co-administration of both drugs led to significantly more synergistic results in terms of reducing cardiac toxicity. In conclusion, montelukast and Klotho either alone or in combination were confirmed to be effective in suppressing DOX-induced cardiac toxicity in rats. [ABSTRACT FROM AUTHOR]

Surface-enhanced Raman spectroscopy (SERS) possesses exquisite molecular-specific properties with single-molecule sensitivity. Yet, translation of SERS into a quantitative analysis technique remains elusive owing to considerable fluctuation of the SERS intensity, which can be ascribed to the SERS uncertainty principle, a tradeoff between "reproducibility" and "enhancement". To provide a potential solution, herein, an integrated multiplexed SERS biosensing strategy is proposed, which features two distinct advantages. First, a subwavelength-structured plasmonic metasurface consisting of alternately stacked metal-dielectric pyramidal meta-atoms is fabricated and could provide simultaneously enhanced electric and magnetic fields to enable spatially extended and weakly wavelength-dependent SERS. Second, nanomechanical perturbations are harnessed to transduce signals in the form of SERS frequency shifts, which are not directly affected by the SERS uncertainty principle. By also employing 3D printing methods, a proof-of-concept study of multiplexed detection of a panel of serum cardiac biomarkers for acute myocardial infarction is provided. Success in the development of both the electric and magnetic fields-active plasmonic metasurfaces could transform future designs of SERS substrates with newly endowed functionalities, and frequency shift-based SERS multiplexing could open new opportunities to develop innovative quantitative optical techniques for applications in chemistry, biology, and medicine., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

High-sensitivity cardiac troponin (hs-cTn) assays have significantly refined the resolution of biomarker-level detection and have emerged as the gold standard cardiac biomarker in evaluating myocardial injury. Since its introduction, hs-cTn has been integrated into the Fourth Universal Definition of Myocardial Infarction and various European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the evaluation and diagnosis of chest pain syndromes. However, despite its integral role in caring for patients with chest pain, there are still substantive gaps in our knowledge of the clinical interpretation of dynamic changes in hs-cTn values. Whether a relative or absolute hs-cTn delta should be used to detect acute myocardial injury remains debatable. There are also emerging considerations of possible sex and racial/ethnic differences in clinically significant troponin deltas. In the emergency department, there is debate about the optimal time frame to recheck hs-cTn after symptom onset for myocardial infarction rule-out and whether hs-cTn deltas should be integrated into clinical risk scores. In this review, we will provide an overview of the history of clinical utilization of cardiac biomarkers, the development of hs-cTn assays, and the ongoing search for a meaningful delta that can be clinically applicable.

Background: Orthostatic hypotension is associated with cardiovascular disease. It remains unclear if low standing blood pressure or high seated blood pressure is responsible for this association. We compared associations of orthostatic hypotension and hypertension with high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide., Methods: We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized controlled trial funded by the National Institute on Aging, between July 2015 and May 2019. Participants were community-dwelling adults, 70 years or older. Blood tests for high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide were drawn at visits concurrent with blood pressure measurements. Secondary analysis occurred in 2023. We determined associations between blood pressure phenotypes and cardiac biomarkers., Results: Of 674 participants (mean age 76.5 ± 5.4 years, 43% female, 17.2% Black race), 29.1% had prior cardiovascular disease. Participants with seated hypertension had 10.1% greater high-sensitivity cardiac troponin I (95% CI = 3.8, 16.9) and 11.0% greater N-terminal pro-B-type natriuretic peptide (4.0, 18.6) than those without seated hypertension. Participants with standing hypertension had 8.6% (2.7, 14.9) greater high-sensitivity cardiac troponin I and 11.8% greater N-terminal pro-B-type natriuretic peptide (5.1, 18.9) than those without standing hypertension. Hypotensive phenotypes were not associated with either biomarker., Conclusions: Both seated and standing hypertension were associated with greater high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, but hypotensive phenotypes were not. Hypoperfusion may not be the principal mechanism behind subclinical cardiac injury among older adults with orthostatic hypotension., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: COVID-19, caused by the SARS-CoV-2 virus, has generated a global pandemic with a wide range of clinical manifestations. Cardiovascular complications are frequently observed in individuals with COVID-19, particularly those with preexisting cardiovascular risk factors or diseases. Cardiac biomarkers, including troponin, natriuretic peptides, and inflammatory markers, play a vital role in risk stratification, diagnosis, monitoring, and prognosis in COVID-19 patients. These biomarkers provide valuable insights into cardiac injury, myocardial stress, inflammation, and the prediction of adverse cardiovascular outcomes. This review aims to provide better understanding of how Cardiac biomarkers correlate to clinical manifestation of COVID-19., Methods: We retrieved studies from PubMed, Medline, and Google Scholars that included results on cardiac biomarkers in COVID-19. Total of 14 studies were reviewed., Results: 8 studies showed evidence of poor progression of the disease when there is increased troponin. 6 studies out of the 14 mentioned in this review showed positive correlation between mortality and elevation in cardiac biomarkers. This shows the significance of cardiac biomarkers in predicting the mortality in patients with COVID-19., Conclusion: It was shown that elevated cardiac biomarkers were associated significantly to poor outcome of covid-19 infection. The outcomes that were linked to increased cardiac biomarkers included increased length of hospitalization, need of life sustaining treatment, myocarditis, invasive and non-invasive respiratory support, and even death were linked to elevated cardiac biomarkers levels.

Purpose: Phytochemicals have been found effective in reducing the oxidative stress and damage to cardiovascular and other tissues. In this study, the effects of alantolactone (AL) on cardiac parameters in rabbits exposed to artificially-induced oxidative stress were investigated., Method: The oxidative stress was induced in a group of White New Zealand rabbits by injecting 40% hydrogen peroxide solution (1 ml/kg body weight) thrice with an interval of 72 h. The hydrogen peroxide-treated animals were orally treated with AL extracted from the roots of Inula helenium (1 ml/kg repeated thrice after 72 h). Blood samples were taken before and after the hydrogen peroxide and AL treatments, and the sera were subjected to analysis of oxidative damage in terms of malondialdehyde content (MDA), total antioxidant activity (TAOA), linoleic acid reduction capacity (LARC), hydroxyl radical scavenging capacity (HRSC), 2,2-diphenyl-1-picrylhydrazyl radical scavenging capacity (DPPH RSC), superoxide dismutase activity (SOD) and catalase activity, and cardiac parameters including troponin-I content (Trop-I), creatine kinase-MB (CKMB), aspartate transaminase (AST)., Results: The hydrogen peroxide treatment substantially enhanced MDA content and SOD activity and decreased LARC, HRSC, DPPH, and catalase activity. The AL treatment significantly decreased MDA content, TAOA, Trop-I, CK-MB, and AST levels and increased LARC, DPPH RSC, HRSC, and catalase activity., Conclusion: The observed effect of AL treatment on the animals' oxidative stress, antioxidant status, and cardiac biomarkers emphasizes that AL may effectively manage oxidative stress and cardiac damage., Competing Interests: Conflict of interest: The authors assert no contention of interest regarding this study., (© the Author(s).)

Objectives: In this study, the effects of short-duration high-intensity exercise and long-duration exercise on high-sensitivity cardiac troponin T (hs-cTnT) levels were compared., Methods: Twelve male amateur cyclists performed 1- and 6-h cycling trials. In both exercise trials, hs-cTnT was assessed at rest, immediately postexercise and at 1, 3, 6, 12, and 24 h postexercise. Additionally, hs-cTnT levels were assessed every hour during the 6-h trial., Results: Exercise resulted in an increase in hs-cTnT levels in all subjects. Circulating hs-cTnT levels increased in both exercise trials (p < 0.001), with higher peak values occurring after the 1-h trial compared with those of the 6-h trial (p = 0.023). The upper reference limit (URL) exceeded 83 % of the participants in the 1-h trial and 42 % of the participants in the 6-h trial. There was substantial individual variability in peak hs-cTnT in both trials. Values of hs-cTnT were greater after exercise than during exercise for the 6-h trial. For both exercise trials, the maximum postexercise hs-cTnT values correlated with the %HR MAX (r = 0.906 for the 1-h trial, r = 0.735 for the 6-h trial). For the 1-h trial, the maximum postexercise hs-cTnT values were observed at 3 h in all subjects. No significant difference in the hs-cTnT values was observed for the 6-h trial during the first 12 h postexercise., Conclusions: Our results demonstrated greater hs-cTnT levels in young male participants after a 1-h cycling trial than after a 6-h cycling trial, despite a substantially greater energy expenditure and total external work completed in the 6-h trial. Postexercise hs-cTnT values are associated with relative exercise intensity., Competing Interests: Declaration of interest statement The authors declare no competing interests. The study was conducted following the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Clinical Research Ethics Committee of Aragón., (Copyright © 2024 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: An increase in cardiac biomarkers is a prerequisite for diagnosing periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG). Early-phase risk detection may be aided by modeling time-dependent serum creatine kinase-MB (CK-MB) concentrations. This study aimed to model the kinetics of CK-MB while identifying its influencing factors., Methods: Patients who underwent elective CABG and had CK-MB measurements within 72 hours postoperatively were included. The primary outcome was the modeled post hoc kinetics of CK-MB in patients without potential PMI. These patients were defined as having no potential PMI based on the absence of ischemic electrocardiographic abnormalities, imaging abnormalities, in-hospital cardiac arrest, mortality, or postoperative unplanned catheterization. A web-based application was created using mixed-effect modeling to provide an interactive and individualized result., Results: A total of 1589 CK-MB measurements from 635 patients who underwent elective isolated CABG were available for analysis. Of these, 609 patients (96%) had no potential PMI and 26 (4%) had potential PMI. Male sex, aortic cross-clamp time, and cardioplegia type significantly impacted CK-MB concentrations. The diagnostic accuracy of the model had an area under the receiver operating characteristic curve of 82.8% (95% confidence interval, 72.6%-90.2%). A threshold of 7 μg/L yielded a sensitivity of 94% and a specificity of 80% (positive predictive value, 17%; negative predictive value, 99%) for excluding potential PMI in our study population., Conclusions: CK-MB release after CABG depends on the timing of measurement, patient sex, aortic cross-clamp time, and cardioplegia type. The model (available at https://www.cardiomarker.com/ckmb) can be validated, reproduced, refined, and applied to other biomarkers., Competing Interests: Conflict of Interest Statement A.M.A.M. reports nonfinancial support from Abbott Diagnostics and Roche Diagnostics. A.W.J.V.H. reports unrestricted institutional grants from Abbott, Roche, Medtronic, Boehringer Ingelheim, and Astra Zeneca. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract Aims Cardio‐oncology is a growing interdisciplinary field which aims to improve cardiological care for cancer patients in order to reduce morbidity and mortality. The impact of cardiac biomarkers, echocardiographic parameters, and cardiological assessment regarding risk stratification is still unclear. We aimed to identify potential parameters that allow an early risk stratification of cancer patients. Methods and results In this cohort study, we evaluated 930 patients that were admitted to the cardio‐oncology outpatient clinic of the University Hospital Heidelberg from January 2016 to January 2019. We performed echocardiography, including Global Longitudinal Strain (GLS) analysis and measured cardiac biomarkers including N‐terminal pro brain‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T levels (hs‐cTnT). Most patients were suffering from breast cancer (n = 450, 48.4%), upper gastrointestinal carcinoma (n = 99, 10.6%) or multiple myeloma (n = 51, 5.5%). At the initial visit, we observed 86.7% of patients having a preserved left ventricular ejection fraction (LVEF >50%). At the second follow up, still 78.9% of patients showed a preserved LVEF. Echocardiographic parameters or elevation of NT‐proBNP did not significantly correlate with all‐cause mortality (ACM) (logistic regression LVEF

Objective: To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality. Methods: We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients. Results: A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14–1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07–1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51–0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21–1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39−0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57–1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37–0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29–0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38–0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63–1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32–0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45−0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection. Conclusion: Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.

Abstract Background Infective endocarditis (IE) in dogs is associated with severe disease and a high case fatality rate but often presents with nonspecific clinical signs. Hypothesis/Objectives Serum concentration of cardiac troponin‐I (cTnI) is elevated in dogs with IE and can differentiate dogs with IE from dogs with other diseases with similar clinical features. Concentration of serum cTnI is negatively correlated with survival time in dogs with IE. Animals Seventy‐two client‐owned dogs; 29 with IE, 27 with stage‐B myxomatous mitral valve disease (MMVD), and 16 with immune‐mediated disease (IMD). Methods Retrospective clinical cohort study. Concentration of serum cTnI was measured in all dogs at time of diagnosis. Clinical findings and echocardiographic interpretation were also recorded. Statistical analyses included Kruskal‐Wallis test, pairwise Mann‐Whitney U tests, receiver operator characteristic, and Cox proportional hazards. Results Serum concentration of cTnI was significantly higher in the IE group (0.69 ng/mL [0.03‐80.8]) than in the MMVD (0.05 ng/mL [0.02‐0.11], P 0.625 ng/mL are supportive of IE.

Background/PurposeThis study aims to quantify the utility of monitoring LVEF, hs-cTnT, and NT-proBNP for dynamic cardiotoxicity risk assessment in women with HER2+ early breast cancer undergoing neoadjuvant/adjuvant trastuzumab-based therapy.Materials and methodsWe used joint models of longitudinal and time-to-event data to analyze 1,136 echocardiography reports and 326 hs-cTnT and NT-proBNP measurements from 185 women. Cardiotoxicity was defined as a 10% decline in LVEF below 50% and/or clinically overt heart failure.ResultsMedian pre-treatment LVEF was 64%, and 19 patients (10%) experienced cardiotoxicity (asymptomatic n = 12, during treatment n = 19). The pre-treatment LVEF strongly predicted for cardiotoxicity (subdistribution hazard ratio per 5% increase in pre-treatment LVEF = 0.68, 95%CI: 0.48–0.95, p = 0.026). In contrast, pre-treatment hs-cTnT and NT-proBNP were not consistently associated with cardiotoxicity. During treatment, the longitudinal LVEF trajectory dynamically identified women at high risk of developing cardiotoxicity (hazard ratio per 5% LVEF increase at any time of follow-up = 0.36, 95% CI: 0.2–0.65, p = 0.005). Thirty-four patients (18%) developed an LVEF decline ≥ 5% from pre-treatment to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and pre-treatment LVEF ≥ 60% (n = 117), 15.9% in those with early LVEF decline or pre-treatment LVEF < 60% (n = 65), and 66.7% in those with early LVEF decline and pre-treatment LVEF < 60% (n = 3), (Gray’s test p < 0.0001).ConclusionCardiotoxicity risk is low in two thirds of women with HER2+ early breast cancer who have pre-treatment LVEF ≥ 60% and no early LVEF decline > 5% during trastuzumab-based therapy. The longitudinal LVEF trajectory but not hs-cTnT or NT-proBNP allows for a dynamic assessment of cardiotoxicity risk in this setting.

Summary: Background: Plasma cardiac markers may assist in prediction of incident cardiovascular disease. Methods: The incremental value of cardiac Troponins (T and I) and NT-proBNP added to risk factors in the PREDICT score for incident cardiovascular disease (CVD) in primary care, was assessed in 4102 asymptomatic participants in a randomised controlled trial of Vitamin D (ViDA). Findings were corroborated in 2528 participants in a separate community-based observational registry of CVD-free volunteers (HVOLS). Findings: Hazard ratios for first cardiovascular events adjusted for PREDICT risk factors, comparing fifth to first quintiles of marker plasma concentrations, were 2.57 (95% CI 1.47-4.49); 3.01 (1.66-5.48) and 3.38 (2.04-5.60) for hs-cTnI, hs-cTnT and NT-proBNP respectively. The C statistic for discrimination of the primary endpoint increased from 0.755 to 0.771 (+0.016, p = 0.01). Cardiac marker data correctly reclassified risk upwards in 6.7% of patients and downwards in 3.3%. These findings were corroborated by results from HVOLS. Interpretation: Increments in plasma cardiac biomarkers robustly and reproducibly predicted increased hazard of incident CVD, independent of established risk factors, in two community-dwelling populations. Cardiac markers may augment risk assessment for onset of CVD in primary care. Funding: ViDA was funded by the Health Research Council of New Zealand (grant 10/400) and the Accident Compensation Corporation. HVOLS was funded by the Health Research Council of NZ Programme Grants (grants 02/152 and 08/070) and by grants from the Heart Foundation of NZ and the Christchurch Heart Institute Trust. Roche Diagnostics provided in-kind support for NT-proBNP and hs-cTnT assays and Abbott Laboratories for hs-cTnI assays.

Renal cell carcinoma, an aggressive malignancy, is often incidentally diagnosed. The patient remains asymptomatic to the late stage of the disease, when the local or distant metastases are already present. Surgical treatment remains the choice for these patients, although the plan must adapt to the characteristics of the patients and the extension of the neoplasm. Systemic therapy is sometimes needed. It includes immunotherapy, target therapy, or both, with a high level of toxicity. Cardiac biomarkers have prognosis and monitoring values in this setting. Their role in postoperative identification of myocardial injury and heart failure already have been demonstrated, as well as their importance in preoperative evaluation from the cardiac point of view and the progression of renal cancer. The cardiac biomarkers are also part of the new cardio-oncologic approach to establishing and monitoring systemic therapy. They are complementary tests for assessment of the baseline toxicity risk and tools to guide therapy. The goal must be to continue the treatment as long as possible with the initiation and optimisation of the cardiological treatment. Cardiac atrial biomarkers are reported to have also antitumoral and anti-inflammatory properties. This review aims to present the role of cardiac biomarkers in the multidisciplinary management of renal cell carcinoma patients.

Background: Patients with chronic obstructive pulmonary disease (COPD) often have cardiovascular comorbidities. Patients of COPD with cardiovascular complications tend to have more symptoms and a higher mortality than do patients with COPD alone. There are several cardiac biomarkers such as Troponin-T, creatine phosphokinase-MB (CPK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP) which can be used to detect cardiac dysfunction in patients of COPD. Retrospective studies suggest that plasma levels of NT-proBNP and cardiac Troponin-T are often elevated in patients with acute exacerbations of COPD and are associated with increased mortality. Aims and Objectives: In this study, we assessed the presence of cardiac dysfunction in patients presenting with acute exacerbation of COPD (AECOPD) by using cardiac biomarkers proBNP, Troponin-T, and CPK-MB. Patients were followed up for 30 days to know the relationship between cardiac dysfunction and outcome in terms of repeated admissions, intensive care units (ICU) admissions, and/or mortality. Methodology: Ninety patients of AECOPD were enrolled in our study. A detailed history was taken and physical examination performed in these patients. All patients in the study were subjected to hematological and biochemical investigations. ProBNP, Troponin-T, and CPK-MB were measured within 48 h of admission as measure of cardiac dysfunction; and outcome was assessed in terms of mortality, ICU admission, and repeated admissions within 30 days of admission. Results: Among the study population, 77.77% had at least one deranged cardiac biomarker, and 18.88% of populations had all the three biomarkers of cardiac dysfunction deranged. 24 out of the 90 participants required ventilatory support in the form of noninvasive or invasive ventilation. 7.14% of the study population had repeated admissions, 24.28% had ICU admissions and 11.43% had mortality. All of them had deranged cardiac biomarkers. There was a significant association between deranged proBNP and ICU admission and mortality (P = 0.0151 and 0.0217, respectively). COPD was more prevalent in the age group of 50-70 years and in males. ProBNP levels were significantly elevated in patients who required ventilatory support (P = 0.003). Conclusions: Cardiac dysfunction is common during exacerbations of COPD and portends a poor prognosis. Cardiac dysfunction was more prevalent in the elderly. Patients with deranged cardiac biomarkers had a greater number of ICU admissions, repeated hospital admissions, and a higher mortality. In the follow-up, elevated proBNP was found to be a strong marker for predicting ICU admission, mortality, and repeated admissions. [ABSTRACT FROM AUTHOR]

This study aimed to provide reliable pediatric reference values for N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive Troponin T (hsTnT) obtained from a population of well children and investigate for associations with sex, pubertal status, body mass index (BMI), and serum lipid levels. We analyzed hsTnT and NT-proBNP values obtained from 4826 samples provided by 2522 children aged 0.25–18 years participating in a prospective longitudinal population-based cohort study, "LIFE child" in Leipzig, Germany (Poulain et al., Eur J Epidemiol 32:145–158, 2017). NT-proBNP values decreased throughout childhood from values over 400 ng/L at 3 months to 138 ng/L in females and 65 ng/L in males by 18 years of age. Values dropped rapidly with advancing pubertal stage. We found a strong association between lower NT-proBNP values and higher BMI or elevated serum lipids, the latter effect being more pronounced in males. For hsTnT levels, approximately half of the measurements were below the detection limit. However, 76% of those aged 3 months and 21% of those aged 6 months had values exceeding the adult cut-off limit. Females had slightly higher levels in the first 2 years of life but this was reversed during puberty. In males, there was an upward trend from pubertal stage 2 onward. We identified a positive association between hsTnT and BMI but a negative association with low-density lipoprotein (LDL) cholesterol and triglyceride levels in boys but not in girls. Based on a large number of healthy children, we have established reliable reference values for NT-proBNP and hsTnT for use in everyday clinical practice. We have also identified important associations between certain metabolic and cardiac markers. Clinical Trial Registration ClinicalTrial.gov (NCT02550236). [ABSTRACT FROM AUTHOR]