Advanced Cardiac Biomarkers & Their Clinical Significance
1. High-Sensitivity Cardiac Troponins (hs-cTnI, hs-cTnT)
Clinical significance
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Gold-standard biomarkers for myocardial injury.
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Detect minute troponin elevations → early diagnosis of myocardial infarction (MI).
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Useful for risk stratification (e.g., rule-in/rule-out MI algorithms).
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Elevated in non-ischemic injury: myocarditis, renal failure, HF.
2. Copeptin
Clinical significance
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Surrogate marker for arginine vasopressin (AVP).
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Rises immediately during acute stress → complements troponin for ultra-early MI rule-out.
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Helps differentiate causes of polyuria and hyponatremia in other contexts.
3. Heart-Type Fatty Acid Binding Protein (H-FABP)
Clinical significance
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Very early marker of myocardial injury (elevates within 30 minutes).
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More sensitive than CK-MB in early MI.
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Useful where hs-troponin is not available.
4. Myeloperoxidase (MPO)
Clinical significance
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Marker of oxidative stress & plaque instability.
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Elevated in patients at risk for acute coronary events.
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Helps distinguish plaque rupture from other causes of chest pain.
5. Soluble ST2 (sST2)
Clinical significance
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Biomarker of myocardial strain, inflammation, and fibrosis.
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Strong prognostic indicator in heart failure (HF).
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Less affected by age, BMI, renal function → stable and reliable.
6. Galectin-3
Clinical significance
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Marker of inflammation and cardiac fibrosis.
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Approved for risk stratification in chronic heart failure.
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High levels indicate poor prognosis and likelihood of HF progression.
7. Growth Differentiation Factor-15 (GDF-15)
Clinical significance
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Stress, inflammation, and oxidative injury marker.
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Predicts mortality and adverse outcomes in:
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Heart failure
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ACS
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Atrial fibrillation
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8. High-Sensitivity C-Reactive Protein (hs-CRP)
Clinical significance
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Sensitive marker of systemic inflammation.
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Strongly predicts cardiovascular risk and future coronary events.
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Used in population-level risk stratification (e.g., atherosclerosis progression).
9. NT-proBNP / BNP (Advanced assays)
Clinical significance
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Biomarkers for ventricular wall stress.
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Diagnose and monitor heart failure severity.
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High levels → increased risk of hospitalization and mortality.
10. MR-proANP (Mid-Regional Pro-Atrial Natriuretic Peptide)
Clinical significance
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Stable fragment of atrial natriuretic peptide.
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Useful for diagnosis of acute dyspnea and HF when BNP results are uncertain.
11. MR-proADM (Mid-Regional Pro-Adrenomedullin)
Clinical significance
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Marker of endothelial dysfunction and vascular stress.
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Predicts mortality in heart failure, sepsis, and ACS.
12. Ischemia-Modified Albumin (IMA)
Clinical significance
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Increases during early myocardial ischemia before necrosis happens.
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Helps in early detection when troponin is still normal.
13. Cardiac MicroRNAs (miRNAs: miR-1, miR-133a, miR-208, miR-499)
Clinical significance
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Emerging biomarkers for:
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Acute MI
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Myocardial remodeling
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Heart failure progression
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May allow highly sensitive detection of cardiomyocyte injury.
14. Lipoprotein-Associated Phospholipase A2 (Lp-PLA2)
Clinical significance
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Marker of vascular inflammation.
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Associated with unstable atherosclerotic plaque and stroke risk.
15. FGF-23 (Fibroblast Growth Factor-23)
Clinical significance
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Elevated in chronic kidney disease and HF.
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Predicts LV hypertrophy, HF hospitalization, and mortality.
16. Glycogen Phosphorylase BB (GPBB) –
An enzyme isoform (Isoenzyme) found in heart and brain cells; released into blood when cardiac cells become ischemic.
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Rise: Very early—within 1–4 hours of myocardial ischemia.
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Significance:
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Early marker of ischemia, even before cell death occurs.
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Helpful in early acute coronary syndrome (ACS) when troponin may still be normal.
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More specific for cardiac ischemia than CK-MB.
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Limitations: Less specific than troponin; not widely used in clinical guidelines.