Role Of Biomarkers In Patients Research Articles

Relation of biomarkers of inflammation, oxidative stress and fibrosis in patient with atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. The patogenesis of AF is linked to an inflammatory reaction and oxidative stress that leads to fibrosis of the atria and progression of the disease. However, the role of different biomarkers in patients with AF is poorly defined. The purpose of this study is to define the role of several biomarkers of inflammation, oxidative stress and fibrosis (myeloperoxidase (MPO), high-sensitivity C-reactive protein (hsCRP), galectin-3 (Gal-3), oxidized low-density lipoprotein (oxLDL)) in patients with AF. Methods We included 75 patients with paroxysmal/persistent AF, who were admitted for electrical cardioversion or pulmonary vein isolation. MPO, hsCRP, Gal-3 and oxLDL were measured before the procedures. We compared the results with 75 healthy age-, sex- and blood pressure-matched individuals. Results Patients with AF had higher MPO (77.1 vs 41.7 ng/ml, p<0.001) compared the healthy subjects. There was also significantly higher hsCRP (3.7 vs 1.6 mg/L, p<0.001) and Gal-3 (12.3 vs 10.4 mg/L, p=0.003). No difference in oxLDL levels (78.8 vs 75.3 U/L, p=0.414) were seen (Table 1). MPO (β=0.012, p=0.014), hsCRP (β=0.213, p=0.046), and weight (β=0.037, p=0.006), were independently associated with AF in a logistic regression analysis (Table 2). Conclusions Patients with AF have increased markers of inflammation and fibrosis, whereas no increase in oxidative stress markers was detected. MPO, hsCRP and age weight were independently predictive of AF. These findings support the role of inflammatory and fibrotic mechanisms as important factors in the electrical and structural remodelling progress in the atria of patients with AF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council

The Prognostic Role of Biomarkers in Patients With Chronic Heart Failure

Objective Investigate the role of biomarkers in the prognosis of the clinical course of the disease in patients with chronic heart failure (CHF) of different NYHA functional classes (FC).Material and Methods The study included 132 patients with CHF: Group 1 was composed of 70 patients with NYHA FC II CHF, and Group 2 included 62 patients with FC III-IV CHF. The patients underwent clinical, instrumental, functional, and laboratory measurements, which included serum concentrations of NT-proBNP, ST-2, galectin-3, and C-reactive protein. Patients were examined at baseline and at 3, 6, and 12 mos of follow-up. The following cardiac complications were used as endpoints: urgent hospitalization due to decompensated CHF, heart transplantation, cardiovascular death. Endpoints were registered during the 12-mo follow-up period.Results Endpoints were recorded for 58 patients (44%) of the total sample of patients with CHF: 38 patients were urgently hospitalized, 10 patients underwent heart transplantation, 10 patients died. Cardiac complications were recorded at a higher rate in patients with FC III-IV CHF (63% vs. 27% of patients with FC II; p<0.001). In FC II CHF patients, the incidence of cardiac complications was significantly correlated with NT-proBNP blood concentrations (Rpb=0.53; p=0.023), left ventricular end-diastolic volume (LVEDV) (Rpb=0.50; p=0.044), and mitral regurgitation (Rpb=0.53; p=0.038). Cardiac complications in patients with FC III-IV CHF were associated with ST-2 (Rpb=0.52; p=0.004) and galectin-3 (Rpb=0.46; p=0.009) blood concentrations, and with systolic pulmonary artery pressure (PAP) (Rpb=0.41; p=0.014). Unlike other laboratory measurements, galectin-3 concentrations were significantly correlated with type 2 diabetes mellitus (DM2) (Rpb=0.40; p=0.003). In this study, correlation analysis and evidence of significant differences in the concentrations of biomarkers provided a rationale for identifying potential predictors of severe cardiac complications during medium- and long-term follow-up periods in patients with CHF of different severity: NT-proBNP concentrations in FC II patients; ST-2 and galectin-3 serum concentrations in FC III-IV patients; galectin-3 concentrations in patients with CHF and DM2.Conclusion NT-proBNP blood concentrations are associated with CHF severity and serious cardiac complications in patients with FC II CHF within the following 12 mos. The poor prognosis of FC III-IV CHF is associated with the concentration of the ST-2 biomarker. The blood concentration of galectin-3 is a significant predictor of poor prognosis in patients with CHF and DM2. Predictors of the adverse course of CHF of varying severity were differentiated. For FC II CHF, NT-proBNP > 1723 pg/ml or, if NT-proBNP < 1723 pg/mL, then EDV > 311 ml. For FC III-IV CHF, ST-2 > 67 ng/mL or, if ST-2 < 67 ng/mL, then PAP > 61 mm Hg. Galectin-3 has a prognostic value for the clinical course of the disease at different follow-up periods in patients with CHF and DM2: galectin-3 concentrations > 16 ng/mL and 13-16 ng/mL are risk factors for mid- and long-term cardiac complications, respectively.

Abstract 25: Prognostic Role of NT-ProBNP in Out-Of-Hospital Cardiac Arrest

Introduction: The role of cardiac biomarkers in patients after out-of-hospital cardiac arrest (OHCA) has been subject to recent research due to myocardial stress and injury associated with cardiac arrest. However, it remains unclear to what extent NT-proBNP can be used as a prognostic tool after OHCA. Hypothesis: Baseline NT-proBNP is an independent predictor of mortality in patients after OHCA. Methods: Multicenter retrospective observational cohort study including non-traumatic OHCA patients presenting from 2/1/2017 to 4/1/2019. Relationship between NT-proBNP quartiles and mortality was assessed through unadjusted and adjusted (age, gender, presenting rhythm) analyses with logistic regression. Results: Baseline NT-proBNP values were obtained for 283 patients on presentation after OHCA with median 965 pg/mL (IQR 157-3550). Levels did not differ by arrest etiology (cardiac vs noncardiac) or presenting rhythm. NT-proBNP levels correlated with age (r = 0.44, p<0.0001), but not with lactate, CPR duration, or intra-arrest epinephrine. Overall in-hospital mortality was 68% (196/283). Mortality increased in a stepwise fashion among patients in increasing quartiles of NT-proBNP level (Figure). Mortality rate in Q1: 59% ( 42/71), Q2: 61% (43/70), Q3: 75% (54/72), Q4: 77% (54/70). Odds Ratios (OR) vs Q1 as reference: Q2 OR 1.10 [95% CI 0.56-2.17] p= 0.48; Q3 OR 2.08 [95% CI 1.01-4.17] p= 0.045; Q4 OR 2.33 [95% CI 1.11-4.76] p=0. 023. After adjusting for age, gender, and shockable rhythm there remained a stepwise relationship between higher mortality with increasing NT-proBNP quartile (Q2 OR 1.30 [95% CI 0.61-2.78] p= 0.78; Q3 OR 2.33 [95% CI 1.05-5.26] p= 0.038; Q4 OR 2.50 [95% CI 1.05-5.88] p= 0.039). Conclusion: In this multicenter cohort of patients with shockable and nonshockable OHCA, increased levels of NT-proBNP were predictive of an increased risk of in-hospital mortality even after adjustment for age, gender, and presenting rhythm.

Vascular biomarkers: research methods, indicators, clinical, prognostic value and perspectives

The article deals with modern terminology, methods of studying of the rigidity of blood vessels, their diagnostic value. Taking into account the class and level of evidence, a modern understanding of the diagnostic significance, sensitivity of methods for the study of vessel rigidity has been offered. The role of vascular biomarkers in patients with various diseases is considered. The potential for therapeutic effects on vascular biomarkers has been observed based on the latest consensus documents, meta-analyses. The issue that has not yet been included in the consensus documents — the relationship between vessel rigidity and cognitive impairments — is considered separately. The role of vascular rigidity in the development of the syndrome of small cognitive impairments and the possibility of their therapeutic correction have been demonstrated. In conclusion, the authors state that for today a huge work has been done to study the rigidity of blood vessels, which allowed the creation of general consensus documents. Various scientific researches using non-invasive methods for the study of vascular rigidity, which is of fundamental importance in the selection of pharmacological therapy, seem promising. The practitioner should be informed in the problem of vascular biomarkers in order to evaluate these studies.

Biomarkers for Stroke

BackgroundMajor stroke clinical trials have failed during the past decades. The failures suggest the presence of heterogeneity among stroke patients. Biomarkers refer to indicators found in the blood, other body fluids or tissues that predicts physiologic or disease states, increased disease risk, or pharmacologic responses to a therapeutic intervention. Stroke biomarkers could be used as a guiding tool for more effective personalized therapy.Main ContentsThree aspects of stroke biomarkers are explored in detail. First, the possible role of biomarkers in patients with stroke is discussed. Second, the limitations of conventional biomarkers (especially protein biomarkers) in the area of stroke research are presented with the reasons. Lastly, various types of biomarkers including traditional and novel genetic, microvesicle, and metabolomics-associated biomarkers are introduced with their advantages and disadvantages. We especially focus on the importance of comprehensive approaches using a variety of stroke biomarkers.ConclusionAlthough biomarkers are not recommended in practice guidelines for use in the diagnosis or treatment of stroke, many efforts have been made to overcome the limitations of biomarkers. The studies reviewed herein suggest that comprehensive analysis of different types of stroke biomarkers will improve the understanding of individual pathophysiologies and further promote the development of screening tools for of high-risk patients, and predicting models of stroke outcome and rational stroke therapy tailored to the characteristics of each case.