GALECTIN-3 FOR HEART FAILURE RISK STRATIFICATION IN PATIENTS AFTER ACUTE CORONARY SYNDROMES (ACS): INSIGHTS FROM THE SOLID-TIMI 52 TRIAL

Abstract BACKGROUND Sex-based differences exist in the circulating concentrations of certain novel and established biomarkers in patients with acute coronary syndromes (ACS) and heart failure (HF). However, to date, few studies have compared the diagnostic and prognostic utility of these markers in men vs women. CONTENT This mini-review contains a discussion of the published reports of studies that have explored whether differences in biomarker concentrations exist between men and women with ACS or HF. It also examines those studies that have compared the utility of biomarkers for diagnosis or risk stratification in women vs men. Because biomarkers are often used to make therapeutic and triage decisions in patient care, the potential clinical implications for any observed differences in biomarker reference limits for men and women is discussed. SUMMARY Although the concentration distributions may differ between men and women for certain biomarkers in clinical use, the clinical implications of these observations remain unclear. Because elements of the pathophysiology of ACS and HF may differ between the sexes, further research is needed to better evaluate the diagnostic and prognostic utility of biomarkers in men vs women.

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Natriuretic peptides and multimarker approach to risk stratification of patients with acute coronary syndromes

Medicinski pregled ◽

10.2298/mpns0606248m ◽

2006 ◽

Vol 59 (5-6) ◽

pp. 248-252 ◽

Cited By ~ 2

Author(s):

Radomir Matunovic ◽

Aleksandar Stojanovic ◽

Zdravko Mijailovic ◽

Zoran Cosic

Keyword(s):

Heart Failure ◽

Risk Stratification ◽

Natriuretic Peptides ◽

Acute Coronary Syndromes ◽

Cardiac Biomarkers ◽

Therapeutic Implications ◽

Coronary Syndrome ◽

Brain Natriuretic Peptides ◽

Coronary Syndromes ◽

St Elevation

Natriuretic peptides in acute coronary syndromes Brain natriuretic peptides (BNP) and N-terminal prohormone brain natriuretic peptides (N-proBNP) have been shown to provide important prognostic information in patients with acute coronary syndrome (ACS). Ischemia may be an important stimulus for BNP release. This does not imply, however, that BNP is useful for diagnosing ischemia, and BNP is unlikely to prove sensitive or specific enough for this purpose. Significance of natriuretic peptides in assessing prognosis in patients with acute coronary syndromes In patients with ST-elevation and non-ST-elevation myocardial infarction, higher BNP and N-proBNP levels have been shown to predict a grater likelihood of death or heart faiulure, independent of other prognostic factors. Therapeutic implications of BNP elevation in acute coronary syndromes Patients with BNP or NT-proBNP elevation following ACS are clearly at high risk for death and for developement of heart failure, but specific therapeutic implications of BNP elevation have not been defined. In particular, it is not known how patients with BNP elevation should be treated considering the fact that they have normal troponin levels and no clinical evidence of heart failure. Multimarker strategies for risk stratification in acute coronary syndromes It has been shown recently that in patients with acute coronary syndromes the risk increased sequentially among those with one, two or three elevated biomarkers. Therapeutic applications of cardiac biomarkers in acute coronary syndromes Multimarker strategies, that incorporate panels of cardiac bio?markers, are likely to be used in the future for risk stratification and for pathophysiologically-guided treatement of patients with ACS.

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Biomarkers in acute coronary syndromes

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0033 ◽

2021 ◽

pp. 400-408

Author(s):

Jasper Boeddinghaus ◽

Thomas Nestelberger ◽

Raphael Twerenbold ◽

Christian Mueller

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Risk Stratification ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Acute Coronary Syndromes ◽

Acute Chest Pain ◽

High Sensitivity ◽

Coronary Syndromes ◽

Rule Out

Biomarkers, particularly high-sensitivity cardiac troponin T/I (hs-cTnT/I), play a major role in the early diagnosis and risk stratification of patients presenting with symptoms suggestive of an acute coronary syndrome such as acute chest pain. As heart specific markers of cardiomyocyte injury, hs-cTnT/I complement clinical assessment and the 12-lead electrocardiogram in the diagnosis of myocardial infarction, the risk stratification for life-threatening arrhythmias and death, and the triage towards early revascularization. Hs-cTnT/I allow the reliable measurement of cTnT/I concentrations around the 99th-percentile and in the normal range and increased the diagnostic accuracy for myocardial infarction at presentation. Absolute short-term changes in hs-cTnT/I within 1h or 2h further increase the diagnostic accuracy for myocardial infarction. The ESC hs-cTnT/I 0/1h-algorithms are assay-specific early triage algorithms optimized for the early rule-out and/or rule-in of myocardial infarction. They triage patients towards rule-out (about 60%), observe (about 25%), and rule-in (about 15%). Triage towards rule-out provides very high sensitivity (99%) and negative predictive value (>99%) for the safe rule-out of myocardial infarction, while triage towards rule-in provides high specificity (about 96%) and positive predictive value (about 75%) for myocardial infarction. Other biomarkers quantifying cardiomyocyte injury (e.g. CK-MB, CK, LDH, myosin-binding protein C) or other pathophysiological processes involved in acute coronary syndromes (e.g. copeptin, BNP, NT-proBNP) provide no or only very little incremental diagnostic value for myocardial infarction on top of the ESC hs-cTnT/I 0/1h-algorithms. However, the later provide incremental prognostic value for death and heart failure. Therefore, the use of BNP or NT-proBNP, as quantitative markers of hemodynamic stress and heart failure, should be considered.

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