Novel cardiac biomarkers and multiple-marker approach in the early detection, prognosis, and risk stratification of cardiac diseases

Table 1 Overview of novel cardiac biomarkers: Their pathophysiological roles, clinical applications, and associated cardiovascular diseases

Biomarker	Pathophysiological role	Clinical application	Associated CVDs
MicroRNAs (miR-1, miR-133a, miR-208b, miR-499)	Gene regulation, myocardial injury & fibrosis	Diagnosis & prognosis, especially in MI and HF	MI, HF, HCM, CAD, myocarditis
Long non-coding RNAs (CHAST, MHRT)	Cardiac hypertrophy, fibrosis, gene expression	Biomarker & therapeutic target	HF, atherosclerosis, CAD
ST2 (soluble ST2)	Inflammation, fibrosis, IL-33 pathway	Prognosis, particularly in HF	HFpEF, HFrEF
Heart-type FABP	Myocardial injury, lipid metabolism	Early MI detection, prognosis in CAD & CKD	MI, CAD, CKD
Galectin-3	Fibrosis, inflammation	Diagnostic and prognostic utility	HF, congenital heart disease, AF
OPG	Vascular calcification, inflammation	Risk stratification, prognostication	CAD, AMI, HF, atherosclerosis
GDF-15	Inflammation, fibrosis, cellular stress	Prognostic tool, especially in MI and HF	MI, HF, PH, AF
MMP-2/MMP-9	ECM remodeling, plaque rupture	Risk stratification, disease progression	ACS, HCM, KD, Chagas disease
OPN	Inflammation, fibrosis	Diagnostic and prognostic biomarker	HFpEF, myocarditis, CAD, RV failure
Adrenomedullin & copeptin	Vasodilation, fluid regulation	Early MI detection, HF prognosis	MI, HF, HTN
MPO	Oxidative stress, neutrophil activation	Prognosis, inflammation indicator	HF, MI, AF, cardio-oncology
PTX3	Acute-phase response, inflammation	Early CVD detection, ACS diagnosis	MI, atherosclerosis
Placental growth factor	Angiogenesis, inflammation	MI prognosis, vascular remodeling	ACS, MI, CAD
EMP	Endothelial dysfunction, inflammation	Surrogate for vascular injury, prognosis	CAD, SIRS, stroke
ET-1	Vasoconstriction, hypertrophy	Risk prediction, prognosis in HF	HF, CAD, MI, PAH, HTN
NRG-1	Cardiomyocyte survival, angiogenesis	Prognostic and therapeutic implications	HF, MI, CAD
NGAL	Inflammation, renal dysfunction	Risk stratification in HF and MI	HF, MI, CRS
Cystatin C	ECM remodeling, renal marker	Predictor of MACE, mortality	MI, HF, metabolic syndrome
ADMA/SDMA	Nitric oxide inhibition, endothelial dysfunction	Prediction of MACE and CAD risk	MI, HF, HCM, CAD
Uromodulin	BP regulation, renal protection	Prognostic marker, especially in males	HF, CAD, CKD
sLOX-1	Inflammation, plaque instability	Early diagnosis of ACS, CVD risk prediction	MI, CAD, psoriasis-associated CVD
AGEs	Oxidative stress, inflammation	Prognosis and early detection, especially in diabetes	HF, CAD, T2DM-related CVD

ACS: Acute coronary syndrome; ADMA: Asymmetric dimethylarginine; AF: Atrial fibrillation; AGEs: Advanced glycation end products; AMI: Acute myocardial infarction; BP: Blood pressure; CAD: Coronary artery disease; CHAST: Cardiac Hypertrophy-Associated Transcript; CKD: Chronic kidney disease; CRS: Cardiorenal syndrome; CVD: Cardiovascular disease; ECM: Extracellular matrix; EMPs: Endothelial microparticles; ET-1: Endothelin-1; FABP: Fatty acid binding protein; GDF-15: Growth differentiation factor-15; HCM: Hypertrophic cardiomyopathy; HF: Heart failure; HFpEF: Heart failure with preserved ejection fraction; HFrEF: Heart failure with reduced ejection fraction; HTN: Hypertension; KD: Kawasaki disease; MACE: Major adverse cardiovascular events; MHRT: Myosin Heavy-chain-associated RNA Transcripts; MMP: Matrix metalloproteinase; MI: Myocardial infarction; MPO: Myeloperoxidase; NGAL: Neutrophil gelatinase-associated lipocalin; NRG-1: Neuregulin-1; OPG: Osteoprotegerin; OPN: Osteopontin; PAH: Pulmonary arterial hypertension; PH: Pulmonary hypertension; PTX3: Pentraxin 3; RV: Right ventricle; SDMA: Symmetric dimethylarginine; sLOX-1: Soluble lectin-like oxidized LDL receptor-1; SIRS: Systemic inflammatory response syndrome; ST2: Suppression of tumorigenicity 2; T2DM: Type 2 diabetes mellitus.