Novel biomarkers to assess the risk for acute coronary syndrome: beyond troponins
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IM - REVIEW
Novel biomarkers to assess the risk for acute coronary syndrome: beyond troponins Andrea Piccioni1 · Federico Valletta1 · Christian Zanza1 · Alessandra Esperide1 · Francesco Franceschi1 Received: 12 June 2020 / Accepted: 25 June 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Current diagnostic biomarkers for ACS are mainly represented by troponin I and troponin T. Dosing of these two molecules often leads to false positive results, since their plasma levels can increase in several different systemic settings. Therefore, identification of new markers able to detect patients with acute coronary syndromes is an emerging priority. On this view, many studies have been performed on different microRNAs, mitochondrial peptides, inflammatory cytokines and adhesion molecules with very promising results. Besides their introduction in screening programs, further studies are now needed in the acute setting, beyond or in association with troponin levels. This will help to better discriminate the real occurrence of an ACS in many patients accessing the emergency department for chest pain. Keywords Acute coronary syndrome · Biomarkers · MicroRNAs · Mitochondrial peptides · Cytokines · Adhesion molecules
Introduction To date, cardiovascular diseases represent the leading cause of death worldwide and, according to the World Health Organization, ischemic heart disease (IHD) and stroke rank among the top. Despite several attempts to realize reliable prediction models, we still cannot rely on efficient tools to estimate patient’s risk of developing acute coronary syndromes (ACS) for all individuals [1]. While current diagnostic biomarkers for ACS are mainly represented by troponin I (TnI) and troponin T (TnT). Dosing of these two molecules often leads to false positive results, since their plasma levels can increase in several different settings, such as heart failure, chronic kidney disease and sepsis and many other conditions [2, 3]. Moreover, blood levels of cardiac troponins only rise after myocardial cell death, a process that usually takes place after 2–4 h from the ischemic event, and they remain detectable in the peripheral blood for days [4]. Therefore, identification of new strategies to early detect patients with ACS is an emerging priority as * Andrea Piccioni [email protected] 1
Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
it may allow to start an immediate treatment thus reducing mortality [1]; in this regard, a large number of studies have been conducted to identify a set of new biomarkers useful for an early assessment of ACS. In this review, we provide an update of the most recent literature about those novel biomarkers, with a special focus on microRNAs (Mir), mitochondrial peptides, inflammatory cytokines and adhesion molecules.
MicroRNAs According to our research, miR-146a, miR-26a, miR-499 and miR-34 were the most studied (Table 1). As for miR-146a,
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