Perspectives on cardiovascular biomarkers: one fits all biomarkers are out, personalization is in.

Abstract

in this issue of Biomarkers, 8 exceptional abstracts of the “17th annual Biomarkers and Personalised Medicine in Cardiovascular disease Symposium” are published [https:// doi.org/10.1080/1354750X.2023.2205221]. these abstracts reflect current trends in cardiovascular biomarkers clinical needs and topics including markers of cardiac injury and infarction (abstracts no. 1, 2 and 6), of contrast nephropathy (abstract no. 3), of arrhythmias (abstract no. 4 and 8), acute heart failure (abstract no. 5) and infection (abstract no 7). it is noteworthy that despite the fact that the actual guidelines of the European Society of Cardiology (ESC) do not support other biomarkers than cardiac troponin for the assessment of patients with suspected acute coronary syndrome (aCS) (Collet et al., 2020) Cepin et al. (abstract no. 6) highlight with two instructive case reports that CK-MB may close unmet needs of high-sensitive troponin (hstn) although CK-MB is thought to be of no benefit any more (Jaffe et al., 2021). the authors highlight that in patients with concomitant disease like renal failure and in late presenters, CK-MB dynamics help to be more precise in individual decision making than cardiac troponin alone. Wong et al. (abstract 1) found that there are relevant “Ethnic differences in High-Sensitivity Cardiac troponin t among Patients with Chest Pain in the Emergency department” leading to under-diagnosis of acute myocardial infarction among asians. in summary, both abstracts challenge the “one fits all strategy” using hstn of the current ESC guideline, which has been criticized by others regarding different biomarkers before (Möckel et al, 2020). titus et al. (abstract no. 2) provide proof of concept using a transdermal wearable device to detect cardiac injury. the device was used in conjunction with a neural network. the system was able to differentiate patients with cardiac injury from normal subjects with a supreme C-statistic of 0.96 (Ci: 0.95 − 0.99). it is obvious that this approach has the potential to change the current standards of the evaluation of suspected aCS specifically in a community and emergency medical services setting. Potentially, unnecessary transportation can be avoided and a combination with telemedical services may form a “mobile emergency department”. the figure summarizes the potential future clinical impact of these results. Nevertheless, future research on these options should include the assessment of possible impact on actual standard pathways and on patient groups with no or limited access to digital devices as the elderly. these and the remaining abstracts provide unique and thought provoking insights in new biomarkers which support personalization of acute cardiovascular medicine. We are looking forward to publishing full length articles on these topics in the near future.