Biomarkers articles within Nature Reviews Cardiology

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  • News & Views |

    Glutathione is considered the major natural antioxidant, protecting cells from oxidative stress. Patel and colleagues used plasma levels of the aminothiols cystine and glutathione to quantify oxidative stress in patients with coronary artery disease, and show that the cystine/glutathione ratio is associated with increased mortality. Is this a new approach for clinical risk stratification?

    • Luc Rochette
    •  & Catherine Vergely

  • Consensus Statement
    | Open Access

    To bridge the current gap between the known mechanisms of atrial fibrillation (AF) and the clinical management of patients with this arrhythmia, Fabritz and colleagues propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. A new, mechanism-based classification of AF can provide the basis for personalized prevention and management.

    • Larissa Fabritz
    • , Eduard Guasch
    •  & Paulus Kirchhof

  • News & Views |

    The introduction of a new high-sensitivity troponin immunoassay might revolutionize the way acute coronary syndrome is diagnosed. The high analytical sensitivity of the assay enables earlier and more accurate identification of myocardial injury than with currently used methods, and also allows for the safe discharge of patients without myocardial ischaemia.

    • Giuseppe Lippi

  • News & Views |

    Among patients with diabetes mellitus and ischaemic heart disease, high-sensitivity testing effectively identified 39.3% of patients with elevated troponin levels who were at high 5-year risk of cardiovascular death, myocardial infarction, or stroke. Compared with optimal medical therapy, revascularization did not reduce ischaemic events among patients with elevated troponin levels.

    • L. Kristin Newby
    •  & E. Magnus Ohman

  • Review Article |

    Measurement of biomarkers is a critical component of cardiovascular care, but sex-specific differences in these markers have not been fully integrated into clinical practice. In this Review, Daniels and Maisel assess the utility of sex-specific cut-off points when measuring cardiac troponins or natriuretic peptides in the diagnosis and prognosis of acute coronary syndrome and heart failure, respectively. They also discuss sex-specific differences in novel cardiovascular biomarkers, such as galectin-3, soluble ST2, and proneurotensin.

    • Lori B. Daniels
    •  & Alan S. Maisel

  • Review Article |

    Resistance to diuretic therapy to achieve decongestion is common in patients with acute heart failure. In this Review, ter Maaten and colleagues describe the pathophysiology and mechanisms of diuretic resistance, how to evaluate diuretic response, and propose a treatment strategy for patients with acute heart failure who are diuretic resistant.

    • Jozine M. ter Maaten
    • , Mattia A. E. Valente
    •  & Adriaan A. Voors

  • News & Views |

    Biomarkers are needed to accurately represent or predict clinical outcomes for optimal management of patients with atrial fibrillation (AF) in clinical practice. Growth differentiation factor-15, a member of the transforming growth factor-β family, has an independent prognostic role for major bleeding and death in patients with AF receiving oral anticoagulation.

    • Francisco Marín
    •  & Vanessa Roldán

  • Review Article |

    Pulmonary arterial hypertension (PAH) is an incurable disease associated with high mortality, but early detection of PAH improves long-term survival. In this Review, Lau and colleagues discuss which individuals warrant screening for PAH, such as those with systemic sclerosis, and summarize the variety of diagnostic tests that could be combined into a multimodal approach to optimize the performance of screening algorithms.

    • Edmund M. T. Lau
    • , Marc Humbert
    •  & David S. Celermajer

  • Review Article |

    During stress or injury-induced cardiac remodelling, fibroblasts increase production of extracellular matrix proteins, which leads to fibrosis formation, and consequently, heart failure. In this Review, Thomas Thum describes the contribution of noncoding RNAs to this process, with a specific focus on microRNAs that might be used as future therapeutic targets or biomarkers for cardiac fibrosis.

    • Thomas Thum

  • News & Views |

    In an analysis of electronic health records, 1.25 million patients aged ≥30 years without diagnosed cardiovascular disease experienced 83,098 cardiovascular events during follow-up (median 5.2 years). Associations between incident cardiovascular disease and blood pressure differed for systolic and diastolic blood pressures and between the 12 cardiovascular end points examined.

    • Jan A. Staessen

  • Review Article |

    Dysregulation of the natriuretic peptide system has been associated with several life-style related metabolic and cardiovascular disorders, including obesity, type 2 diabetes mellitus, hypertension, atherosclerosis, thrombosis, and myocardial ischaemia, implying biological effects beyond pressure–volume homeostasis. In this Review, Zois et al. discuss the role of the various natriuretic peptides in the pathophysiology of these cardiometabolic conditions.

    • Nora E. Zois
    • , Emil D. Bartels
    •  & Jens P. Goetze

  • Review Article |

    Cardiac troponins (cTn) are the preferred biomarkers for the noninvasive detection of myocardial injury. However, cTn are not exclusively released as a result of ischaemic myocardial cell necrosis, but also with acute and chronic nonischaemic conditions. In this Review, Giannitsis and Katus describe the causes and the prognostic importance of the release of cTn not related to acute coronary syndromes, and recommend strategies to discriminate between ischaemic and nonischaemic cTn elevation.

    • Evangelos Giannitsis
    •  & Hugo A. Katus

  • News & Views |

    In a study conducted in selected US hospitals, bypassing the emergency department with direct transport to the cardiac catheterization laboratory resulted in a reduced time to reperfusion for patients with ST-segment elevation myocardial infarction. However, this strategy was used infrequently—mostly during working hours—and varied significantly between hospitals.

    • Charles Maynard
    •  & Steven M. Bradley

  • News & Views |

    The diagnosis of obstructive coronary artery disease (CAD) can be challenging and relies on noninvasive imaging methods and coronary angiography. Advances in genetic technologies have enabled large-scale gene-expression studies. A gene-expression score has been shown to predict the presence of obstructive CAD.

    • Jose D. Vargas
    •  & Joao A. C. Lima

  • Review Article |

    A key aim of personalized medicine is to optimize the prevention, diagnosis, and treatment of diseases by tailoring them to individual patient characteristics and genetics. In this Review, Henry Völzke and colleagues describe the methodological and statistical features of study design that will allow personalized medicine to be translated from a promising theoretical concept to a clinically beneficial, cost-effective reality in cardiovascular medicine.

    • Henry Völzke
    • , Carsten O. Schmidt
    •  & Heyo K. Kroemer

  • Year in Review |

    Studies published in 2012 in the field of HDL research have provided further evidence suggesting that a low HDL-cholesterol level, in the absence of related lipid or nonlipid risk factors, is not associated with increased risk of coronary heart disease.

    • Jean-Pierre Després

  • News & Views |

    Adding C-reactive protein (CRP) level to conventional cardiovascular risk models has been suggested to improve risk prediction for cardiovascular events. However, evaluation of the potential impact of CRP measurement in cardiovascular risk management will require studies designed to quantify the effect of additional CRP assessment on medical decision-making, patient outcomes, and cost-effectiveness.

    • Sanne A. E. Peters
    • , Frank L. J. Visseren
    •  & Diederick E. Grobbee

  • News & Views |

    A 3-h algorithm using high-sensitivity assays for cardiac troponin to rule out myocardial infarction (MI) is recommended in current ESC guidelines. Whether faster rule-out algorithms can discriminate between MI and other conditions that elevate the troponin level, or be safely implemented across the whole spectrum of patient risk, is unclear.

    • Evangelos Giannitsis
    •  & Hugo A. Katus

  • News & Views |

    The concept that raising HDL-cholesterol level will uniformly translate into cardiovascular risk reduction has been challenged by genetic epidemiology studies and large-scale, randomized clinical trials. Studies suggest that we should go beyond HDL cholesterol, and consider emerging biomarkers of HDL concentration, composition, and functionality as surrogates for cardiovascular risk reduction.

    • Benoit J. Arsenault
    •  & Jean-Pierre Després

  • Review Article |

    Myocardial infarction is a major cause of morbidity and mortality worldwide. In this consensus document, experts from the ESC, ACCF, AHA, and WHF update the universal definition and classification of myocardial infarction to integrate the latest evidence on the detection of myocardial injury and necrosis using biomarker assays and imaging techniques.

    • Kristian Thygesen
    • , Joseph S. Alpert
    •  & Harvey D. White

  • Opinion |

    Despite advances in prevention of cardiovascular disease, a high proportion of cardiac events occur in asymptomatic people who do not have a high level of risk. Much remains unknown about the value of novel risk markers for the identification of candidates for primary prevention. Here, Polonsky and Greenland argue that clinical trials of these markers in asymptomatic, low-risk populations are greatly needed to determine their effectiveness.

    • Tamar S. Polonsky
    •  & Philip Greenland

  • Review Article |

    The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years to meet the need for earlier diagnosis, better risk stratification, and cost-effective treatment. In this state-of-the-art Review, Drs Maisel and Choudhary provide an update on biomarkers used for the diagnosis and management of patients with acute HF, as well as non-HF markers indicative of damage to the organs and systems most-commonly affected by HF.

    • Alan S. Maisel
    •  & Rajiv Choudhary

  • Review Article |

    Molecular biomarkers could provide a window into the pathophysiology of chronic heart failure, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. In this Review, Ahmad et al. examine some emerging biomarkers of the biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occur in chronic heart failure, and discuss their potential role within a multimarker-based strategy.

    • Tariq Ahmad
    • , Mona Fiuzat
    •  & Christopher O'Connor

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