Biomarkers

IJCS

Original Article

Systemic Inflammation, Fibrinogen, and Lipoprotein(a) as Composite Predictors of Peripheral Arterial Disease

Alim Namitokov et al. Karina Karabakhtsieva Irina Gilevich

Abstract

Background:

Early detection of peripheral atherosclerosis remains a clinical challenge, especially in asymptomatic individuals. This study aimed to evaluate the predictive value of systemic inflammatory indices and lipid-related biomarkers for early atherosclerosis.

Objectives:

To investigate the diagnostic value of systemic inflammation indices, fibrinogen, and lipoprotein(a) as individual biomarkers and as a combined predictive model for early peripheral arterial disease.

Methods:

A prospective case-control study was conducted in 54 individuals: 20 patients diagnosed with early peripheral atherosclerosis (<55 years) and 34 healthy controls. Laboratory data included complete blood count, lipid profile, fibrinogen, lipoprotein(a), angiopoietin-like protein 3 (ANGPTL3), and Lp-PLA₂. Inflammatory indices, including NLR, PLR, SII, SIRI, AISI, and MLR, were calculated. Logistic regression and ROC analysis were performed. A two-sided p-value < 0.05 was considered statistically significant.

Results:

SIRI (1.70 vs. 0.93, p = 0.0039) and AISI (431.6 vs. 236.4, p = 0.0128) were significantly higher in the atherosclerosis group. Fibrinogen showed the most robust association (5.46 vs. 3.71 g/L, p < 0.00001). Lp(a) alone was not statistically different between groups but improved the multivariate model (AUC 0.85 vs. 0.82). The final model, including age, inflammatory indices, LDL, Lp (a), and fibrinogen, achieved an AUC of 0.91.

Conclusion:

Systemic inflammation and fibrinogen levels are strongly associated with early atherosclerosis. Their combination with lipoprotein(a) enhances diagnostic performance, offering a simple, cost-effective strategy for early vascular risk assessment.

Ler artigo completo

IJCS

Editorial

Systemic Biomarkers in Heart Failure: To Measure or Not to Measure?

Humberto Villacorta

Heart failure (HF) is an aggressive disease with unfavorable prognosis if not treated properly. Even after optimal medical treatment, some patients may remain at high risk for clinical events. As such, it is important to identify patients at risk of death or hospitalization. Biomarkers have been used to establish prognosis in HF, and natriuretic peptides (NP) are considered the gold standard biomarker in HF, not only for diagnosis but also for prognosis.

NP are cardiac biomarkers, produced by the heart ventricles in response to wall stretch. However, several systemic biomarkers, reflecting different pathways, have been shown to be elevated in HF with the potential to add information on top of NP ().^– Nevertheless, these biomarkers have not been strongly recommended in HF guidelines because their utility in aiding decision-making is unclear.

[…]

Ler artigo completo

IJCS

Original Article

The Relationship Between Inflammatory Markers and Supraventricular Tachycardia in Children

Sevval Durgut et al. Hikmet Kıztanır Yasin Yıldız

Abstract

Background

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases.

Objectives

This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted.

Results

There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group.

Conclusions

Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

Ler artigo completo

IJCS

Viewpoint

Biomarkers and Mononuclear Inflammatory Activity in COVID-19 Survivors

Marcio Carvalho et al. Antonio Lagoeiro

Introduction

COVID-19 has globally impacted 522 million people and caused 6 million deaths, despite the administration of 12 billion vaccine doses. Beyond respiratory effects, the virus has led to complications in the cardiovascular, hematological, and nervous systems, potentially resulting in organ dysfunction and death. Individuals with pre-existing medical conditions such as hypertension, diabetes mellitus, coronary artery disease, heart failure, and chronic kidney disease are associated with worse prognoses. Increased long-term mortality risk is observed, especially in the elderly population, regardless of the acute phase severity.

COVID-19 affects multiple organs beyond the lungs, including various cardiovascular diseases such as myocarditis, acute myocardial infarction, stress cardiomyopathy, arterial and venous thromboembolism, pericarditis, and arrhythmias. The pathophysiological mechanisms include systemic inflammation (cytokine storm), coagulopathy, direct viral invasion, hypoxemia, electrolyte imbalance, and fever.

[…]

Ler artigo completo

IJCS

Original Article

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Duvan Arley Galindes-Casanova et al. Edith Norela Benitez-Escobar Luis Álvaro Melo-Burbano Nelson Eduardo Murillo-Benitez … Juan Carlos Avila-Valencia Jorge Enrique Daza-Arana

Abstract

Background:

Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement.

Objective:

To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection.

Methods:

This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level.

Results:

This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4–24.5.

Conclusions:

Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

Ler artigo completo

IJCS

Original Article

miR-27a/b Level is Associated with ABCA1 Expression and is a Potential PBMC-Based Biomarker for Coronary Artery Disease

Farshad Mirzavi et al. Safieh Ebrahimi Arezoo Rajabian Hossein Hosseini Behnam Alipoor

Abstract

Background:

Coronary artery disease (CAD) is the most common form of cardiac disease with high morbidity and mortality rates.

Objectives:

In this study, we evaluated the expression of miR-27a and miR-27b as biomarkers in peripheral blood mononuclear cells (PBMCs) of patients with CAD and investigated its correlation with cholesterol-efflux transporter, ATP-binding cassette transporter A1 (ABCA1).

Method:

This study was performed on 54 men with CAD and 51 healthy, sex- and age-matched control participants. The expression of miR-27a/b and ABCA1 genes in PBMCs were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression of ABCA1 was assessed by Western blotting. Concurrently, the specificity and sensitivity of miR-27a/b was evaluated through receiver operating characteristic (ROC) curve. The significance level adopted in the statistical analysis was 5%.

Results:

We found that miR-27a and miR-27b expression were significantly increased, while both mRNA and protein expression of ABCA1 were markedly reduced in the PBMCs of CAD patients in comparison to non-CAD controls. miR-27a/27b expression was also shown to be inversely correlated with ABCA1. ROC analysis showed that the miR-27a had an area under the ROC curve (AUC) of about 92.6 (sensitivity 83.3٪ and specificity 86.6٪) and miR-27b had an AUC of about 93.0 (sensitivity 86.6٪ and specificity 80.0 (%, suggesting the diagnostic potential of miR-27a/b in CAD patients.

Conclusions:

Our data suggested a possible role of miR-27a/b in CAD pathogenesis. Additionally, we proposed that miR-27a/b expression in PBMCs may have potential clinical implications in the diagnosis of CAD patients, but further validations in large cohorts are required.

Ler artigo completo

IJCS

Editorial

Neuropeptides Y and Other Promising Biomarkers in Acute Coronary Syndrome

Fernanda A. Andrade et al. Leonardo Carvalho Pedro Gabriel Melo de Barros Silva

Neuropeptide Y (NPY) is a very common neurotransmitter with 36 amino acids that acts as a stimulator of angiogenesis, inflammation and adipogenesis through the NPY2 receptor. The description of high plasma concentrations of NPY in acute coronary syndrome (ACS) and left ventricular dysfunction and its close relationship with the sympathetic nervous system reinforces the possibility of a new prognostic biomarker for risk stratification.^,

In recent years, changes in the NPY signalling pathway have been related to ACS. For example, the NPYc.20T>C mutation is associated with increased serum lipid levels and consequent increase in the risk of ACS, stroke, hypertension, and obesity.^, The NPYc.-485T>C variant has been linked to the development of early atherosclerosis and stroke, and possibly to insulin resistance reduction and development of type 2 diabetes mellitus.^–

[…]

Ler artigo completo

IJCS

Editorial

Cardiotrophin-1 in Patients with Acute Coronary Syndromes: Does it Have a Role?

Humberto Villacorta

Acute coronary syndromes are among the most common diagnoses in the emergency department (ED). It has been estimated that 300,000 to 400,000 cases are seen each year in Brazil. The diagnosis of acute myocardial infarction (AMI) is made on the basis of symptoms, electrocardiogram, and biological markers of myocardial necrosis. Troponins are the most specific cardiac markers, and in the era of highly sensitive assays, they have been shown to make the exclusion of AMI in the ED more rapid, being particularly helpful in patients with atypical presentations.

Cardiotrophin-1 (CT-1) is a member of the interleukin-6 superfamily of proinflammatory cytokines. It is expressed in many tissues, including heart and vessels. CT-1 is upregulated in cardiac fibroblasts and cardiomyocytes in response to mechanical, humoral, metabolic, and hypoxic stress (). It is elevated in the myocardium and plasma of heart failure (HF) patients and has also been associated with hypertension, diabetes, cardiac hypertrophy, and fibrosis, both in patients and experimental studies., CT-1 is expressed after an AMI and seems to be involved in the healing and remodeling process that occurs after myocardial infarction., In the study by Freed et al., CT-1 was able to initiate each of the processes related to scar formation, including fibroblast migration and proliferation, and collagen synthesis.

[…]

Ler artigo completo

IJCS

Original Article

Optimal Cutoff of the TG/HDL-c ratio for Cardiovascular Risk in Hypertensive and Diabetic Patients Monitored by Primary Health Care in a city in Minas Gerais

Eunice Ferreira da Silva et al. Rosângela Minardi Mitre Cotta Érica Toledo Mendonça Deíse Moura de Oliveira … Silvia Almeida Cardoso Renata Maria Colodette Tiago Ricardo Moreira

Abstract

Background

The analysis of the atherogenic potential of the lipid profile for biomarkers, such as the TG/HDL-c ratio, predicts cardiovascular risk better than isolated lipids.

Objective

To identify the TG/HDL-c cutoff points for multiple risks (hypertension, Diabetes Mellitus, obesity) and to evaluate the association between sociodemographic, clinical, laboratory, anthropometric, and life habit variables and the TG/HDL-c ratio in hypertensive and/or diabetic individuals in the context of Primary Health Care.

Methods

This was a cross-sectional study with 833 hypertensive and/or diabetic patients, conducted between August 2017 and April 2018. The cutoff point of the TG/HDL-c were obtained by the ROC curve. Cardiovascular risk was discriminated by TG/HDL-c, categorized by the cutoff and evaluated in relation to multiple risks. The magnitude of the association between TG/HDL-c and independent variables was estimated by logistic regression. The significance level of p<0.05 was adopted for all tests.

Results

The cutoff values of TG/HDL-c (3.26 for men and 2.72 for women) were more sensitive and less specific than those in the literature. Women (OR=1.90 and 95% CI 1.13-3.20) and men (OR=4.58 and 95% CI 1.78-11.76) with multiple risks, and white men, alcohol users, with a history of stroke, had a higher chance of altered GT/HDL-c. Increases in glycosylated hemoglobin, glycemia, and phosphorus in women, and cholesterol, glycemia, and microalbuminuria in men increased the chances of altered TG/HDL-c. Being a former smoker and black reduced the chance of altered TG/HDL-c in women.

Conclusions

TG/HDL-c proved to be a good indicator for habitual use in Primary Care.

Ler artigo completo

IJCS

Case Report

Kounis Syndrome: Case Report in Goiânia/BR

Marília Pereira et al. Gabriela Lima Vieitas Anna Ilona Hunkar Freitas Karoly Gyula Olivas Hunkar

Abstract

22-year-old male patient with no heart disease, who was given an ambulatory medication with analgesics due to an acute renal crisis. After the drug administration, the patient presented dyspnea, cyanosis, and hemoptysis. There was suspicion of anaphylactic shock, which was treated, but there was no improvement in the clinical condition. The patient was referred to the Intensive Care Unit, where tests were performed showing elevated cardiac enzymes and Immunoglobulin E and Computed Tomography of Thoracic revealed alveolar hemorrhage. He developed clinical worsening and died after sepsis. The final diagnosis was of kounis syndrome due to the hypersensitivity reaction to the analgesics introduced in the patient, generating an acute coronary syndrome (ACS). The purpose of this case report was to highlight a syndrome that is little reported because it is not part of the differential diagnosis routines of ACS, but it generates important complications.

Ler artigo completo

IJCS

Editorial

Vascular Aging and Arterial Stiffness in Older Adults

Erika Maria Gonçalves Campana et al. Sayuri Inuzuka

Deaths from cardiovascular disease, according to the WHO, are projected to reach around 14 million by 2030. The global population is aging at an accelerated rate and the prevalence of arterial hypertension (AH) increases with advancing age. Aging is the common denominator in several cardiovascular diseases. Arterial stiffness and increased pulse wave velocity (PWV), as well as central systolic pressure are major predictors of cardiovascular events. ( )

[…]

Ler artigo completo

IJCS

Original Article

Dietary Fat Intake and its Association with Adiposity and Inflammatory Markers in Individuals at Cardiometabolic Risk

Fernanda Santos Fortes et al. Alinne Paula de Almeida Carla de Oliveira Barbosa Rosa Brenda Kelly Souza Silveira … Nínive de Almeida Reis Helen Hermana Miranda Hermsdorff

Abstract

Background

Fatty acids are important components of diet that may influence the development of CVD.

Objective

To verify the relationship of dietary fatty acids with cardiometabolic markers in individuals at the cardiometabolic risk.

Methods

This cross-sectional study involved 282 subjects (116 M/166 F, 42 ± 16 years) attended the Cardiovascular Health Care Program, Universidade Federal de Viçosa (Brazil). Anthropometric and body composition measurements as well as metabolic and inflammatory markers were assessed by standard procedures. Demographic and lifestyle variables were obtained by semi-structured questionnaire. Food consumption was evaluated by 24h recall. Student’s t-test or Mann-Whitney-U test and chi-square test were used, considering the statistical significance level of 5% probability.

Results

Individuals who eaten fat, fatty acids saturated and fatty acids polyunsaturated above recommendation (> 35, 7%, and 10% of caloric intake) were more likely to be overweight (p < 0.05). Those individuals with higher intake of medium-chain fatty saturated acids (≥ 1.05 g/d) had lower values (p < 0.05) of body mass index, waist circumference, waist-hip ratio and waist-height ratio and higher values (p < 0.05) of total leukocytes, C-reactive protein and total cholesterol, and LDL. Subjects with higher of palmitoleic acid intake (≥ 0.94 g/d) presented higher values of BMI, fat percentage and HOMA-IR (p < 0.05).

Conclusion

This cross-sectional study found different associations of dietary fat and cardiometabolic risk related to adiposity and inflammatory markers, according with chain-size and saturation, indicating the need the more detailed on the dietary assessment of obese patients to identify risk factors and established best strategies to control. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Ler artigo completo

IJCS

Review Article

From Echocardiographic Evaluation to Biomarkers Measurement: The Role of Myocardial Dysfunction in Mortality Associated with Sepsis

Márcio da Silva Campista et al. Wolney de Andrade Martins Mariana de Andrade Guedes Antonio José Lagoeiro Jorge

Abstract

Sepsis remains the leading cause of mortality and critical illness worldwide. Myocardial dysfunction is one of the most clinically relevant manifestations of sepsis and results from a complex interaction among genetic, molecular, metabolic, and structural changes. Despite the prominence given to the occurrence of systolic dysfunction during sepsis, the association between diastolic dysfunction and mortality is controversial, while diastolic dysfunction and right ventricular dysfunction are identified as independent predictors of mortality in the most recent studies. Elevation of biomarkers during sepsis may result from several mechanisms, and although the role of the B-type natriuretic peptide (BNP) and the N-terminal portion of its prohormone (NT-proBNP) as independent predictors of mortality is well defined, the same cannot be said about cardiac troponins due to conflicting results among currently available studies.

The objective of the present review is to discuss the pathophysiological mechanisms of myocardial dysfunction induced by sepsis in adults and the role of echocardiography and cardiac biomarkers as tools for prognostic evaluation in this clinical setting.

Ler artigo completo