Kardiyak Biyobelirteçlere Genel Bakış
Özet
Kardiyovasküler hastalıklar (KVH), dünya genelinde yetişkin ölümlerinin başlıca nedenidir ve 2030 yılına kadar bu kayıpların 22 milyonu aşacağı öngörülmektedir. Akut miyokart enfarktüsü (AMI) gibi durumların erken teşhisi, kalp kası hasarını minimize etmek ve hayatta kalma oranlarını artırmak açısından kritik öneme sahiptir. Acil servislerde uygulanan triaj sistemi, göğüs ağrısı ile başvuran hastalar arasında hayati tehlikesi olanları hızla ayırt etmeyi amaçlar. Biyobelirteçler; hastalık varlığı, risk düzeyi ve tedaviye yanıt hakkında bilgi veren, vücut sıvılarında ölçülebilen maddelerdir. Miyokart hasarının belirlenmesinde kardiyak troponinler (cTnI ve cTnT), yüksek duyarlılıkları nedeniyle en çok tercih edilen belirteçlerdir. Ayrıca inflamasyon süreçlerini yansıtan C-Reaktif Protein (CRP), interlökinler ve fibrinojen gibi göstergeler de tanı ve prognozda değerli bilgiler sunar. Nörohormonal aktivasyonu gösteren BNP ve NT-proBNP gibi peptitler ise kalp yetmezliği ve MI sonrası risk değerlendirmesinde yardımcıdır. Son yıllarda mikroRNA'ların da MI teşhisinde kararlı ve potansiyel yeni belirteçler olduğu görülmüştür. Bu biyobelirteç araştırmaları, gelecekte daha hızlı ve doğru tanı yöntemlerinin geliştirilmesine olanak sağlayacaktır.
Cardiovascular diseases (CVD) are the leading cause of adult mortality worldwide, with projections suggesting deaths may exceed 22 million by 2030. Early diagnosis of conditions like acute myocardial infarction (AMI) is vital for minimizing heart muscle damage and improving survival rates. Triage systems in emergency departments aim to rapidly distinguish life-threatening cases among patients presenting with chest pain. Biomarkers are measurable substances in body fluids that provide information on disease presence, risk levels, and treatment response. Cardiac troponins (cTnI and cTnT) are the preferred markers for identifying myocardial injury due to their high sensitivity. Additionally, inflammatory indicators such as C-Reactive Protein (CRP), interleukins, and fibrinogen offer valuable diagnostic and prognostic data. Peptides reflecting neurohormonal activation, like BNP and NT-proBNP, assist in risk assessment for heart failure and post-MI outcomes. Recently, microRNAs have emerged as stable and potential new markers for MI diagnosis. Ongoing research into these biomarkers will facilitate the development of faster and more accurate diagnostic methods in the future.
Referanslar
Dülek H., Tuzcular Vural Z., Gönenç I. Kardiyovasküler hastalıklarda risk faktörleri. Jour Turk Fam Phy 2018; 09 (2): 53-58. doi: 10.15511/tjtfp.18.00253.
M. Drakopoulou, K. Toutouzas, D. Tousoulis, Acute coronary syndromes, in: D. Tousoulis (Ed.), Coronary Artery Disease: From Biology to Clinical Practice, Elsevier, 2018, pp. 201–233.
Souza TA. Differentiating mechanical pain from visceral pain. In: Mootz RD, Vernon HT, editors. Best practices in clinical practice. 1st ed. US: Aspen Publication; 1999. p.15-17
Miyahara Y, Nagaya N, Kataoka M, et al. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction. Nature medicine. 2006;12(4):459- 465
Streger, M. R. (1998). Prehospital Triage. Emerg Med Serv., 27(6), 23-27
Fernandes, C. M., Tanabe, P., Gilboy, N., Johnson, L. A., McNair, R. S., Rosenau, A. M., Sawchuk, P., Thompson, D. A., Travers, D. A., Bonalumi, N, & Suter, R. E. (2005). Five-Level Triage: A Report from the ACEP/ENA Five Level Triage Task Force. Journal of Emergency Nursing, 31(1), 39-50.
A. Dietl, et al., NT-proBNP predicts cardiovascular death in the general population independent of left ventricular mass and function: insights from a large population based study with long-term follow-up, PLoS One 11 (10) (2016) 1–16.
K. Kara, et al., NT-proBNP is superior to BNP for predicting first cardiovascular events in the general population: the Heinz Nixdorf Recall study, Int. J. Cardiol. 183 (2015) 155–161.
R. Latini, et al., The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT, Eur. Heart J. 25 (4) (2004) 292–299.
T. Keller, et al., Sensitive troponin I assay in early diagnosis of acute myocardial infarction, N. Engl. J. Med. 361 (9) (2009) 868–877.
N. Van Der Linden, K. Wildi, C. Mueller, Combining high-sensitivity cardiac troponin i and cardiac troponin T in the early diagnosis of acute myocardial infarction, Circulation 138 (10) (2018) 989–999.
Fidan U. ve Aktürk T.B, e-Journal of New World Sciences Academy Engineering Sciences, 1A0067, 5, (1), 79-87.
Sharafi P ve Emre S, Biyobelirteçler ve Lizozomal Depo Hastalıkları. Hacettepe Tıp Dergisi 2010; 41:142-146
Collinson P. Cardiac biomarker measurement by point of care testing - Development, rationale, current state and future developments. Clin Chim Acta. 2020 Sep;508:234-239. doi: 10.1016/j.cca.2020.05.018. Epub 2020 May 25. PMID: 32464138.
Stătescu C, Anghel L, Tudurachi BS, Leonte A, Benchea LC, Sascău RA. From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction. Int J Mol Sci. 2022 Aug 15;23(16):9168. doi: 10.3390/ijms23169168. PMID: 36012430; PMCID: PMC9409468.
Adams JE 3rd, Abendschein DR, Jaffe AS. Biochemical markers of myocardial injury. Is MB creatine kinase the choice for the 1990s? Circulation 1993;88:750-63.
Thygesen, K.; Alpert, J.S.; Jaffe, A.S.; Chaitman, B.R.; Bax, J.J.; Morrow, D.A.; White, H.D.; Mickley, H.; Crea, F.; van de Werf, F.; et al. ESC Scientific Document Group, Fourth universal definition of myocardial infarction (2018). Eur. Heart J. 2019, 40, 237–269
Oprescu N, Micheu MM, Scafa-Udriste A, Popa-Fotea NM, Dorobantu M. Inflammatory markers in acute myocardial infarction and the correlation with the severity of coronary heart disease. Ann Med. 2021 Dec;53(1):1041-1047. DOI: 10.1080/07853890.2021.1916070. PMID: 34180324; PMCID: PMC8245096.
Söğüt Ö, Akdemir T, Can MM. Prognostic value of the C-reactive protein to albumin ratio in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Turk J Med Sci. 2021 Jun 28;51(3):1281-1288. doi: 10.3906/sag-2003-188. PMID: 33453709; PMCID: PMC8283510.
Maisel A, Neath SX, Landsberg J, Mueller C, Nowak RM, Peacock WF, Ponikowski P, Mockel M, Hogan C, Wu AH, Richards M, Clopton P, Filippatos GS, Di Somma S, Anand I, Ng LL, Daniels LB, Christenson RH, Potocki M, McCord J, Terracciano G, Hartmann O, Bergmann A, Morgenthaler NG, Anker SD. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial. Eur J Heart Fail 2012;14:278-286
Vitkon-Barkay I, Lazarovitch T, Marchaim D, Zaidenstein R, Temkin E, Martin ET, Segaloff HE, Litovchik I, Rum V, Richter C, Tzuman O, Vered Z, Minha S. Usefulness of Serum Procalcitonin as a Markerfor Coexisting Infection in Patients With Acute Myocardial Infarction. Am J Cardiol. 2018 Sep 1;122(5):729-734. doi: 10.1016/j.amjcard.2018.05.004. Epub 2018 Jun 2. PMID: 30037423.
Magnus, N.L.; Peder, M.L.; Helge, R.; Torbjørn, O. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit. Rev. Clin. Lab. Sci. 2019, 56, 33–60.
Fanola, C.L.; Morrow, D.A.; Cannon, C.P.; Jarolim, P.; Lukas, M.A.; Bode, C.; Hochman, J.S. Interleukin-6 and the Risk of Adverse Outcomes in Patients After an Acute Coronary Syndrome: Observations From the SOLID-TIMI 52 (Stabilization of Plaque Using Darapladib-Thrombolysis in Myocardial Infarction 52) Trial. J. Am. Heart Assoc. 2017, 6, e005637
Yang, T.; Fang, F.; Chen, Y.; Ma, J.; Xiao, Z.; Zou, S.; Dong, M. Elevated plasma interleukin-37 playing an important role in acute coronary syndrome through suppression of ROCK activation. Oncotarget 2017, 8, 9686–9695.
Çetin M, Erdoğan T, Kırış T, Özer S, Yılmaz AS, Durak H, Aykan AÇ, Şatıroğlu Ö. Predictive value of fibrinogen-to-albumin ratio in acute coronary syndrome. Herz. 2020 Dec;45(Suppl 1):145-151. English. doi: 10.1007/s00059-019-4840-5. Epub 2019 Aug 6. PMID: 31388710.
Chen, Y.; Tao, Y.; Zhang, L.; Xu, W.; Zhou, X. Diagnostic and prognostic value of biomarkers in acute myocardial infarction. Postgrad. Med. J. 2019, 95, 210–216
Liu ZW, Ma Q, Liu J, Li JW, Chen YD. The association between plasma furin and cardiovascular events after acute myocardial infarction. BMC Cardiovasc Disord. 2021 Sep 27;21(1):468. doi: 10.1186/s12872-021-02029-y. PMID: 34579647; PMCID: PMC8477572.
Schwinger RHG. Pathophysiology of heart failure. Cardiovasc Diagn Ther. 2021 Feb;11(1):263-276. doi: 10.21037/cdt-20-302. PMID: 33708498; PMCID: PMC7944197.
Roczek-Janowska M, Kacprzak M, Dzieciol M, Zielinska M, Chizynski K. Prognostic value of copeptin in patients with acute myocardial infarction treated with percutaneous coronary intervention: a prospective cohort study. J Thorac Dis. 2021 Jul;13(7):4094-4103. doi: 10.21037/jtd-21-359. PMID: 34422339; PMCID: PMC8339760.
Christ-Crain M, Morgenthaler N.G, Struck J, Harbarth S, Bergmann A. and Müller B. Midregional pro-adrenomedullin as a prognostic marker
Falkentoft AC, Rørth R, Iversen K, Høfsten DE, Kelbæk H, Holmvang L, Frydland M, Schoos MM, Helqvist S, Axelsson A, Clemmensen P, Jørgensen E, Saunamäki K, Tilsted HH, Pedersen F, Torp-Pedersen C, Kofoed KF, Goetze JP, Engstrøm T, Køber L. MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction-DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy. J Am Heart Assoc. 2018 May 18;7(11):e008123. doi: 10.1161/JAHA.117.008123. PMID: 29776961; PMCID: PMC6015359.
