Cardiac markers: Role in the pathogenesis of arterial hypertension

Cardiac biomarkers may play unique roles in the prognostic evaluation of patients with hypertension,as many cardiac biomarker levels become abnormal long before the onset of obvious cardiovascular disease(CVD).There are numerous cardiac markers.However,this review article only reported the roles of creatinine kinase-MB,cardiac troponins,lipoprotein a,osteopontin,cardiac extracellular matrix,C-reactive protein,cardiac matrix metalloproteinases,cardiac natriuretic peptides,myoglobin,renin,and dynorphin in the pathogenesis of hypertension.This article explained recent major advances,as well as discoveries,significant gaps,and current debates and outlined possible directions for future research.Further studies are required to determine the association between myoglobin and other cardiac markers in hypertension.Moreover,therapeutic approaches are required to determine the early control of these cardiac markers,which ultimately reduce the prevalence of CVDs.

The Association between Methylenetetrahydrofolate Reductase (MTHFR) Mutations and Serum Biomarkers of Cardiac Health

Background: Homocysteine (tHcy) has emerged as a new risk factor for cardiovascular diseases (CVD) The Methylenetetrahydrofolate reductase (MTHFR) polymorphisms are seen to give rise to high levels of tHcy which can be a causative factor in the progression of CVD due to its thrombogenic effect. Serum cardiac biomarkers help in the diagnosis, prognosis, or surveillance of CVD. The present study evaluated the association of the two MTHFR mutations, rs1801133 and rs1801131 with 16 well-established serum cardiac markers. Additionally, the influence of age and gender on the association of the two MTHFR polymorphisms with serum cardiac marker levels was also investigated. Methods: The study was carried out on 1295 individuals who visited Vibrant America Clinical Lab for regular or suspected CVD check-ups. The serological markers and genomic variant analysis were carried out as per the standard laboratory protocol under CLIA. The association between serological markers and the rs1801133 and rs1801131 genetic variants with respect to age and gender was evaluated using a one-way ANNOVA test. Results: No significant association was observed in tHcy levels with respect to gender, however, plasma total tHcy levels were higher in males than females. tHcy levels increased with increasing age in the wild and heterozygous genotypes for the mutations, rs1801133 and rs1801131. Additionally, the serum cardiac markers, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Cholesterol (CHOL), Apolipoprotein A (APOA), Apolipoprotein B (APOB), N-terminal (NT)-pro hormone BNP (BNPNT), LDL calculated (LDLCAL), Small Density Low Density Lipoprotein (SDLDL), APOBAR, Oxidised Low Density Lipoprotein (OXLDL), Lipoprotein (A) (LPA), Triglycerides (TRIG), and Lipoprotein-Associated Phospholipase (Lp-PLA2) Test (PLAC) showed significant associations with respect to gender and age for rs1801133 and rs1801131 (P Conclusions: The present study reports the association of tHcy, HDL, LDL, CHOL, APOA, APOB, BNPNT, LDLCAL, SDLDL, APOBAR, OXLDL, LPA, TRIG, and PLAC with respect to age and gender for the mutations, rs1801133 and rs1801131. We observed that tHcy levels were high in males and the levels increased with increasing age in males for both polymorphisms. rs1801131 mutant males have high levels of triglyceride whereas rs1801133 mutant postmenopausal females showed high levels of cholesterol. Further analysis will be required to understand the pattern of association of the rest of the serum cardiac markers with age and gender for rs1801133 and rs1801131 mutations.

Neurohumoral,cardiac and inflammatory markers in the evaluation of heart failure severity and progression

Heart failure is common in adult population,accounting for substantial morbidity and mortality worldwide.The main risk factors for heart failure are coronary artery disease,hypertension,obesity,diabetes mellitus,chronic pulmonary diseases,family history of cardiovascular diseases,cardiotoxic therapy.The main factor associated with poor outcome of these patients is constant progression of heart failure.In the current review we present evidence on the role of established and candidate neurohumoral biomarkers for heart failure progression management and diagnostics.A growing number of biomarkers have been proposed as potentially useful in heart failure patients,but not one of them still resembles the characteristics of the"ideal biomarker."A single marker will hardly perform well for screening,diagnostic,prognostic,and therapeutic management purposes.Moreover,the pathophysiological and clinical significance of biomarkers may depend on the presentation,stage,and severity of the disease.The authors cover main classification of heart failure phenotypes,based on the measurement of left ventricular ejection fraction,including heart failure with preserved ejection fraction,heart failure with reduced ejection fraction,and the recently proposed category heart failure with mid-range ejection fraction.One could envisage specific sets of biomarker with different performances in heart failure progression with different left ventricular ejection fraction especially as concerns prediction of the future course of the disease and of left ventricular adverse/reverse remodeling.This article is intended to provide an overview of basic and additional mechanisms of heart failure progression will contribute to a more comprehensive knowledge of the disease pathogenesis.

Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure

BACKGROUND Patients with chronic heart failure(CHF)have a progressive disease that is associated with poor quality of life and high mortality.Many patients experience anxiety and depression(A&D)symptoms,which can further accelerate disease progression.We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF.Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.AIM To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.METHODS We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital,Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores.We compared clinical data in the no-A&D,mild-A&D,moderate-A&D,and severe-A&D groups,the SAS and SDS scores with the New York Heart Association(NYHA)functional classification,and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups.Regression analysis was performed on the markers with P<0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve(AUROC)was used to evaluate their accuracy.RESULTS In the inter-group comparison,the following variables had an effect on A&D severity in patients with CHF:NYHA class,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),and tumor necrosis factor-alpha(P<0.05).Other variables did not differ significantly between the A&D groups(P>0.05).In addition,we found that higher NYHA classes were associated with higher the SAS and SDS scores(P<0.05).Regression analysis showed that LVEF,NTproBNP,and IL-6 were independent risk factors for A&D severity(P<0.05).Among them,NT-proBNP had the best predictive ability as a single indicator(AUROC=0.781).Furthermore,the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients(AUROC=0.875).CONCLUSION Cardiac and inflammatory biomarkers,such as LVEF,NT-proBNP,and IL-6,are correlated with A&D severity in patients with CHF and have predictive value.

The early risk stratification of the patients with acute chest pain

Objective： This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram （ECG）, cardiac injury markers and the number of accompanying traditional risk factors（smoking, obesity, hyperlipemia, hypertension, diabetes）, and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods： We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome（ACS） admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram （ECG）, cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups： Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes（without abnormal cardiac injury biomarkers）. Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and 〉2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only ≤ 2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results：After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS（the specificity being 90.7%）. The mortality of group 3 was higher compared with group 4（69.6% vs 53.3%）, however the P value was more than 0.05 and didn＇ t show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation （r= 0.202, P = 0.044） with the number of stenosis being more than 50% of the artery diameter. Multiple linear regression showed the hypertension had a significant correlation with the number of the diseased regions（P= 0.014）. Conclusions：The risk stratification based on the symptom, ECG, cardiac injury markers and accompanying traditional risk factors is both important and available in practice. It is unsuitable for patients with a normal ECG and cardiac injury markers to differentiate ACS from non-cardiac chest pain relying only on the number of the accompanying traditional risk factors. However we found the number of the risk factors can indicate the disease severity.