Modern Biological Markers in cardiology and internal medicine · 2019-11-11 · Assoc.Prof. PD...
Transcript of Modern Biological Markers in cardiology and internal medicine · 2019-11-11 · Assoc.Prof. PD...
Assoc.Prof. PD Dr.med.univ. Michael Lichtenauer, PhD Paracelsus Medical University Salzburg Department of Internal Medicine II, Cardiology
Modern Biological Markers in cardiology and internal medicine
https://de.123rf.com/photo_47545295_herzerkrankungen-klappenerkrankungen-aneurysma-koronare-herzkrankheit-herzrhythmusst%C3%B6rungen-herz-failtu.html
N Engl J Med 2012; 366:2333-2338
Epidemiology
en.wikipedia.org/wiki/Myocardial_infarction Journal of Applied Physiology Published 1 June 2007 Vol. 102 no. 6, 2104-2111 DOI: 10.1152/japplphysiol.00033.2007 http://nyheartfailure.com/heart-failure
Novel Biomarkers in Cardiology
Front. Immunol., 24 April 2017 | https://doi.org/10.3389/fimmu.2017.00475
Novel Biomarkers in Cardiology
The ST2 (Suppression of tumorigenicity 2) and Interleukin-33 system
Cardiovasc Res. 2010 Sep 1;87(4):769-77.
ST2 Regulation
Salzburg 2016
Cardiovasc Res. 2010 Sep 1;87(4):769-77.
ST2 Regulation
Cardiomyocytes Lung alveolar cells
Int. J. Mol. Sci. 2017, 18(4), 783; https://doi.org/10.3390/ijms18040783
ST2 Regulation
Cardiomyocytes
Salzburg 2016
Journal of the American College of Cardiology Volume 70, Issue 19, November 2017 DOI: 10.1016/j.jacc.2017.09.031
ST2 Regulation in Heart Failure
https://en.wikipedia.org/wiki/Heart-type_fatty_acid_binding_protein https://commons.wikimedia.org/wiki/File:Cardiac_Muscle.png https://www.clinlabint.com/detail/clinical-laboratory/heart-fabp-fabp3-elisa/
Novel Biomarkers in Cardiology
H-FABP, Heart-type fatty acid binding protein
https://en.wikipedia.org/wiki/Heart-type_fatty_acid_binding_protein https://commons.wikimedia.org/wiki/File:Cardiac_Muscle.png https://www.clinlabint.com/detail/clinical-laboratory/heart-fabp-fabp3-elisa/
Novel Biomarkers in Cardiology
suPAR, soluble urokinase-type plasminogen activator receptor
Canadian Journal of CardiologyVolume 31, Issue 10, October 2015, Pages 1293-1302
Novel Biomarkers in Cardiology
suPAR, soluble urokinase-type plasminogen activator receptor
GDF-15 as a Target and Biomarker for Diabetes and Cardiovascular Diseases: A Translational ProspectiveRamu Adela, Sanjay Kumar BanerjeePublished in Journal of diabetes research 2015DOI:10.1155/2015/490842
Novel Biomarkers in Cardiology
GDF-15, Growth-differentiation factor 15
Cytokine & Growth Factor ReviewsVolume 26, Issue 3, June 2015, Pages 329-346
Novel Biomarkers in Cardiology
IGFBP-2, Insulin-like growth factor-binding protein 2
en.wikipedia.org/wiki/Myocardial_infarction Journal of Applied Physiology Published 1 June 2007 Vol. 102 no. 6, 2104-2111 DOI: 10.1152/japplphysiol.00033.2007 http://nyheartfailure.com/heart-failure
Novel Biomarkers in Myocardial Infarction
Eur J Clin Invest. 2017 Sep;47(9):638-648.
Novel Biomarkers in Myocardial Infarction
61 Patients with STEMI 57 Patients with NSTEMI 76 Controls (same age, sex,…)
sST2
Control
STEMI
NSTEMI
0
5000
10000
15000
20000
25000*** ***
pg
/ml
suPAR
Control
STEMI
NSTEMI
0
2000
4000
6000
*** ***
pg
/ml
GDF-15
Control
STEMI
NSTEMI
0
500
1000
1500
*****
pg
/ml
H-FABP
Control
STEMI
NSTEMI
0
5
10
15
20
******
ng
/ml
ELISA
https://commons.wikimedia.org/wiki/File:Heart_attack-NIH.gif Circulation. 2004 May 11;109(18):2186-90
Novel Biomarkers in Myocardial Infarction
ST2 and Prognosis
Circulation. 2004 May 11;109(18):2186-90
Novel Biomarkers in Myocardial Infarction
ST2 and Prognosis
Novel Biomarkers in Heart Failure
JACC: Heart Failure Volume 5, Issue 4, April 2017 DOI: 10.1016/j.jchf.2017.01.008
Novel Biomarkers in Heart Failure
Biomarkers in Heart Failure
Biomarkers in Heart Failure
no HF
NYHA I + II
NYHA III + IV
0
10000
20000
30000 **
sS
T2 (
pg
/ml)
no HF
NYHA I + II
NYHA III + IV
0
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4000
5000 *
GD
F-1
5 (
pg
/ml)
no HF
NYHA I + II
NYHA III + IV
0
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10000
15000 ***
su
PA
R (
pg
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no HF
NYHA I + II
NYHA III + IV
0
5
10
15
20
***
**H
-FA
BP
(n
g/m
l)
Biomarkers in Heart Failure
Biomarkers in Heart Failure
Fibrosis
Biomarkers in Heart Failure
with preserved Ejection Fraction
https://www.labmedica.com/clinical-chemistry/articles/294773150/cv-biomarkers-associated-with-incident-heart-failure.html
Biomarkers in Heart Failure
with preserved Ejection Fraction
Targeting Obesity and Diabetes to Treat Heart Failure with Preserved Ejection Fraction July 2017 Frontiers in Endocrinology
Novel Biomarkers in Heart Failure
with preserved Ejection Fraction
Control
ICM
DCM
HFpEF
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< 0.0001
< 0.0001
0.0001
0.0006
sS
T2 (
pg
/ml)
Control
ICM
DCM
HFpEF
0
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1000
1500
0.0039
0.0249
0.0001
GD
F-1
5 (
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/ml)
Control
ICM
DCM
HFpEF
0
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2
3
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< 0.0001
< 0.0001
< 0.0001
< 0.0001
H-F
AB
P (
ng
/ml)
Control
ICM
DCM
HFpEF
0
2000
4000
6000< 0.0001
< 0.0001
0.0038
0.0055
su
PA
R (
pg
/ml)
ICM=ischaemic cardiomyopathy, reduced
EF
DCM=dilative cardiomyopathy, reduced
EF
HFpEF=heart failure with preserved EF
Novel Biomarkers in Heart Failure
Influences of concomitant medication
Ivabradine
Novel Biomarkers in Heart Failure
Influences of concomitant medication
baseline
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baseline
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baseline
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3.0
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4.0 0.0151
H-F
AB
P (
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/ml)
Degenerative Aortic Valve Stenosis
- Prevalence 3% > 75 years
- Degeneration of the valve (reduction of the orifice area from 3-4 cm2 to <1 cm2)
- Without treatment 2 year mortality is 50%
- Typical symptoms are angina pectoris, dyspnea and syncopy
https://de.wikipedia.org/wiki/Erworbene_Aortenklappenstenose https://de.wikipedia.org/wiki/Aortenklappe https://emedicine.medscape.com/article/150638-overview
Therapeutic options
- Surgical aortic valve replacement (SAVR)
https://www.ukr.de/kliniken-institute/innere-medizin-2/Medizinische_Leistungen/Zentrum_f__r_interventionelle_Aortenklappentherapie/TAVI/index.php https://www.heart-valve-surgery.com/heart-surgery-blog/2010/11/24/heart-valve-replacement-failure-aortic/ https://health.clevelandclinic.org/heart-valve-problems-is-repair-or-replacement-best-for-you/
- percutaneous aortic valve replacement (TAVR or TAVI: Transcatheter Aortic Valve Implantation)
- Medical therapy (diuretics)
Novel Biomarkers in TAVI patients
Novel Biomarkers in TAVI patients
Novel Biomarkers in TAVI patients
Novel Biomarkers in TAVI patients
Novel Cardiovascular Biomarkers
in Renal Disease
Novel Cardiovascular Biomarkers
in Renal Disease
Novel Cardiovascular Biomarkers
in Renal Disease
Novel Cardiovascular Biomarkers
in Renal Disease
https://commons.wikimedia.org/wiki/File:Peripheral_Arterial_Disease.gif
Novel Cardiovascular Biomarkers
in Peripheral Artery Disease
Novel Cardiovascular Biomarkers
in Peripheral Artery Disease
Patient characteristics 67-year old female patient
Case Report
was admitted to the Department of Gastroenterology and Hepatology for diagnistic assessment of tumor mass in the liver
presented also signs of right heart failure (ankle edema, aszites), NYHA III
the patient was transferred to the Department of Cardiology for diuretic therapy/re-compensation and further diagnostic work-up
Clinical Status: slightly cyanotic, arrhythmic pulse/atrial fibrillation, systolic heart murmur, slight aszites, lower extremity edema
Transthoracic Echocardiography
massive right atrial dilatation (volume 202 ml), slightly reduced right ventricular function (TAPSE 15 mm), and a large coaptation defect of the tricuspid valve leaflets (23 mm), slighty reduced to normal systolic left ventricular function moderate to severe mitral valve regurgitation, severe tricuspid valve regurgitation
Ebsteins anomaly? Post-inflammatory remodelling?
Transthoracic Echocardiography
massive right atrial dilatation (volume 202 ml), slightly reduced right ventricular function (TAPSE 15 mm), and a large coaptation defect of the tricuspid valve leaflets (23 mm), slighty reduced to normal systolic left ventricular function moderate to severe mitral valve regurgitation, severe tricuspid valve regurgitation
Ebsteins anomaly? Post-inflammatory remodelling?
MRI Exam
Neuroendocrine tumour? Carcinoid?
Further Laboratory Tests
Serum Serotonin: 1248 µg/l (normal range: 117-194 µg/l)
Urinary 5-hydroxyindoleacetic acid: 87 mg/24h (normal range: 2-9 mg/24h) Chromogranin A: 486 U/l (normal range: <34 U/l)
Diagnosis: Carcinoid Syndrom with cardiac involvement
Source: uptodate.com
Dopa-PET-CT
neoplasm in the terminal ileum as primary tumor with three metastases in the liver and metastases in the mesenterial lymph nodes
Further course
To confirm the diagnosis, an ultrasound-guided biopsy of one liver metastasis was performed and a neuroendocrine tumor. The patient underwent Tricuspid valve replacement (Edwards St. Jude Epic, 33mm bioprosthesis) and mitral valve reconstruction (Edwards Physio Ring, 30mm). Two months later, the patient was transferred to the general surgery department and a right hemicolectomy, a cholecystectomy and a bi-segment resection of segment VI and VII of the liver was performed.
Novel Biomarkers other Conditions
Short term exercise
Novel Biomarkers other Conditions
Novel Biomarkers other Conditions
Novel Biomarkers other Conditions
Diavolezza, Switzerland, 2978 meters above sea level
Novel Biomarkers other Conditions
Novel Biomarkers other Conditions
Parabolic Flight Microgravity
Novel Biomarkers other Conditions
Parabolic Flight Microgravity
Baseline
1 hour afte
r flig
ht
24 hour afte
r flig
ht
0
1000
2000
3000
4000 **
***
sS
T2 (
pg
/ml)
Baseline
1 hour afte
r flig
ht
24 hour afte
r flig
ht
0.0
0.5
1.0
1.5
2.0
H-F
AB
P (
ng
/ml)
Baseline
1 hour afte
r flig
ht
24 hour afte
r flig
ht
0
100
200
300
400
500 *
**
GD
F-1
5 (
pg
/ml)
Baseline
1 hour afte
r flig
ht
24 hour afte
r flig
ht
0
500
1000
1500
2000**
su
PA
R (
pg
/ml)
Conclusion
Biomarkers for Cardiovascular
Disease
(sub-clinical) Myocardial
Injury/Ischemia
H-FABP
Inflammation Fibrosis
Hemodynamic Stress
Ventricular Remodeling
ST2
uPAR GDF-15
Physical Exercise
Conclusion
Circulation. 2013 Oct 15;128(16):e240-327.
Troponins
ST2, Galectin-3
Thank you!
Special thanks to: Dr. Bernhard Wernly, Dr. Attila Kiss, Vera Paar, Prof. Uta C. Hoppe, Prof. Bruno Podesser, Dr. Hackl