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Dtsch Med Wochenschr 2023; 148(10): 605-609
DOI: 10.1055/a-1949-1873
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Kardiale Biomarker und ihre klinische Bedeutung

Cardiac biomarkers and their clinical relevance
Thomas Eschenhagen
,
Paulus Kirchhof
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Biomarker bieten quantitative, leicht verfügbare Informationen über Krankheitsprozesse im klinischen Alltag. Ihr Nutzen in der kardiovaskulären Medizin ist durch die Troponine und natriuretischen Peptide belegt. Diese und weitere in Entwicklung befindliche Biomarker haben großes Potenzial für die frühe Erkennung und personalisierte Therapie kardiovaskulärer Erkrankungen.

Abstract

Cardiac biomarkers are an integral, guideline-recommended part of the diagnosis and follow-up of heart diseases. High sensitivity tests for troponin I or T allow for the early diagnosis of myocardial infarction. Rule-in and rule-out algorithms based on the dynamic of plasma concentrations in the first hour after admission improve safe, evidence-based decision making for patients with acute chest pain. Low concentrations of brain natriuretic peptides (BNP or NT-proBNP) reliably exclude heart failure. Elevated BNP/NT-proBNP concentrations are part of the definition of all types of heart failure but require additional tests to diagnose heart failure. Chronic elevations of troponins and BNP/NT-proBNP identify subpopulations at increased risk of cardiovascular events even in the absence of manifest cardiac disease. Whether and how this risk can be reduced requires further evaluation. Several novel biomarkers were recently discovered and characterised. Their place in cardiovascular medicine has yet to be defined.

Kernaussagen

  • Die kardialen Biomarker Troponine und natriuretische Peptide sind heute fester Bestandteil der Diagnostik und Verlaufskontrolle kardialer Erkrankungen.

  • Hochsensitive Tests für Troponin I oder T erlauben die frühe Diagnose eines Myokardinfarktes. Dabei kommt insbesondere der Erfassung der frühen Dynamik der Plasmakonzentrationen Bedeutung zu: im Sinne einer Bestätigung („rule-in“) oder eines Ausschlusses eines Infarkts („rule-out“).

  • Niedrige BNP- oder NT-proBNP-Konzentrationen schließen eine Herzinsuffizienz sicher aus. Erhöhte Werte gehören inzwischen zur Leitlinien-Definition einer Herzinsuffizienz, sind allein aber nicht geeignet, die Diagnose sicherzustellen.

  • Chronische Erhöhungen von Troponin- und BNP-Konzentrationen sind auch ohne manifeste kardiale Erkrankungen prognostisch ungünstig. Studien müssen klären, welche praktischen Konsequenzen dies hat.

  • Weitere Biomarker werden aktuell in ihrer Bedeutung für die kardiovaskuläre Medizin erforscht.

Schlüsselwörter

kardiovaskuläre Biomarker - Troponin I/T - BNP/NT-proBNP - Herzinfarktdiagnostik - Herzinsuffizienz - neue Biomarker

Keywords

cardiovascular biomarkers - Troponin I/T - BNP/NT-proBNP - myocardial infarction - heart failure - new biomarkers - circulating biomolecules


Publication History

Article published online:
27 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • Literatur

  • 1 Kirchhof P, Sipido KR, Cowie MR. et al. The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology. Eur Heart J 2014; 35: 3250-3257 DOI: 10.1093/eurheartj/ehu312. (PMID: 25148837)
    CrossrefPubMedGoogle Scholar
  • 2 Dreyfus JC, Schapira G, Resnais J. et al. Serum creatine kinase in the diagnosis of myocardial infarct. Rev Fr Etud Clin Biol 1960; 5: 386-387 (PMID: 13818103)
    PubMedGoogle Scholar
  • 3 Cummins B, Auckland ML, Cummins P. Cardiac-specific troponin-I radioimmunoassay in the diagnosis of acute myocardial infarction. Am Heart J 1987; 113: 1333-1344 DOI: 10.1016/0002-8703(87)90645-4. (PMID: 3591601)
    CrossrefPubMedGoogle Scholar
  • 4 Katus HA, Remppis A, Looser S. et al. Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. J Mol Cell Cardiol 1989; 21: 1349-1353 DOI: 10.1016/0022-2828(89)90680-9. (PMID: 2632816)
    CrossrefPubMedGoogle Scholar
  • 5 Hamm CW, Goldmann BU, Heeschen C. et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997; 337: 1648-1653 DOI: 10.1056/NEJM199712043372302. (PMID: 9385123)
    CrossrefPubMedGoogle Scholar
  • 6 Neumann JT, Twerenbold R, Ojeda F. et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med 2019; 380: 2529-2540 DOI: 10.1056/NEJMoa1803377. (PMID: 31242362)
    CrossrefPubMedGoogle Scholar
  • 7 Hartter E, Weissel M, Stummvoll HK. et al. Atrial natriuretic peptide concentrations in blood from right atrium in patient with severe right heart failure. Lancet 1985; 2: 93-94
    CrossrefPubMedGoogle Scholar
  • 8 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599-3726 DOI: 10.1093/eurheartj/ehab368. (PMID: 34447992)
    Google Scholar
  • 9 Mebazaa A, Davison B, Chioncel O. et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet 2022; 400: 1938-1952 DOI: 10.1016/S0140-6736(22)02076-1. (PMID: 36356631)
    CrossrefPubMedGoogle Scholar
  • 10 Chua W, Purmah Y, Cardoso VR. et al. Data-driven discovery and validation of circulating blood-based biomarkers associated with prevalent atrial fibrillation. Eur Heart J 2019; 40: 1268-1276
    CrossrefPubMedGoogle Scholar
  • 11 Hijazi Z, Oldgren J, Lindback J. et al. The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet 2016; 387: 2302-2311
    CrossrefPubMedGoogle Scholar
  • 12 Collet JP, Thiele H, Barbato E. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42: 1289-1367
    CrossrefPubMedGoogle Scholar
  • 13 Berry JD, Nambi V, Ambrosius WT. et al. Associations of high-sensitivity troponin and natriuretic peptide levels with outcomes after intensive blood pressure lowering: findings from the SPRINT randomized clinical trial. JAMA Cardiol 2021; 6: 1397-1405
    CrossrefPubMedGoogle Scholar
  • 14 Kroll MH, Twomey PJ, Srisawasdi P. Using the single-compartment ratio model to calculate half-life, NT-proBNP as an example. Clin Chim Acta 2007; 380: 197-202 DOI: 10.1016/j.cca.2007.02.031. (PMID: 17379199)
    CrossrefPubMedGoogle Scholar
  • 15 Kaier TE, Twerenbold R, Puelacher C. et al. Direct comparison of cardiac myosin-binding protein c with cardiac troponins for the early diagnosis of acute myocardial infarction. Circulation 2017; 136: 1495-1508
    CrossrefPubMedGoogle Scholar
  • 16 Reyat JS, Chua W, Cardoso VR. et al. Reduced left atrial cardiomyocyte PITX2 and elevated circulating BMP10 predict atrial fibrillation after ablation. JCI Insight 2020; 5: e139179 DOI: 10.1172/jci.insight.139179. (PMID: 32814717)
    CrossrefPubMedGoogle Scholar
  • 17 Hijazi Z, Benz AP, Lindbäck J. et al. Bone morphogenetic protein 10: a novel risk marker of ischaemic stroke in patients with atrial fibrillation. Eur Heart J 2023; 44: 208-218
    CrossrefPubMedGoogle Scholar
  • 18 Nicolini G, Forini F, Kusmic C. et al. Angiopoietin 2 signal complexity in cardiovascular disease and cancer. Life Sci 2019; 239: 117080 DOI: 10.1016/j.lfs.2019.117080. (PMID: 31756341)
    CrossrefPubMedGoogle Scholar
  • 19 Chua W, Law JP, Cardoso VR. et al. Quantification of fibroblast growth factor 23 and N-terminal pro-B-type natriuretic peptide to identify patients with atrial fibrillation using a high-throughput platform: A validation study. PLoS Med 2021; 18: e1003405
    CrossrefPubMedGoogle Scholar
  • 20 Law JP, Price AM, Pickup L. et al. Clinical potential of targeting fibroblast growth factor-23 and alphaKlotho in the treatment of uremic cardiomyopathy. J Am Heart Assoc 2020; 9: e016041 DOI: 10.1161/JAHA.120.016041. (PMID: 32212912)
    CrossrefPubMedGoogle Scholar