A Review of Novel Cardiac Biomarkers in Acute or Chronic Cardiovascular Diseases: The Role of Soluble ST2 (sST2), Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Myeloperoxidase (MPO), and Procalcitonin (PCT)

Abstract

While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.

Progress in Procalcitonin Detection Based on Immunoassay

“…Notably, a substantial increase in serum PCT is indicative of systemic reactions caused by bacterial infections, distinguishing them from other causes like autoimmune diseases, inflammation, and viral infections, where PCT levels typically remain low [ 144 – 146 ]. A typical study suggested an association between PCT concentrations and infective endocarditis, advocating for a lower PCT threshold to rule out endocarditis in routine clinical practice [ 147 ]. It is essential to highlight that PCT exhibited a rapid increase in severe bacterial infections within a few hours, offering an advantage over other inflammatory factors for early diagnosis [ 148 ].…”

Soluble ST2 for predicting heart failure, atrial fibrillation and death in patients with coronary heart disease with or without renal insufficiency

“…Suppression of tumorigenesis-2 (ST2), a member of the interleukin-1 (IL-1) receptor family, is expressed by vascular cells, myocardial fibroblasts, cardiomyocytes and various circulating immune cells [ 3 , 4 ]. The ST2 gene encodes two subtypes: soluble ST2 (sST2) and transmembrane ST2 (ST2L) [ 5 ]. The interaction between ST2L and IL-33 alleviates cardiac hypertrophy and myocardial fibrosis [ 6 ].…”

Elevated Soluble Suppressor of Tumorigenicity 2 Predict Hospital Admissions Due to Major Adverse Cardiovascular Events (MACE)

“…Inhibition of the interaction between IL-33 and tST2 leads to a reduction of myocardial fibrosis, cardiomyocyte hypertrophy, and apoptosis [8,9], while sST2 removes IL-33 from the circulation, promoting cardiac hypertrophy, fibrosis, and ventricular dysfunction [8]. Additionally, sST2 has been shown to be predictive of both the diagnosis of acute decompensated heart failure (ADHF) and of ADHF mortality; however, the predictive value of sST2 in other CVD states is less well studied, and its ability to predict MACE has not has not been evaluated [10].…”