The heart in distress: Old and new biomarkers

Abstract

Biomarkers are frequently used in the diagnosis of cardiovascular diseases. In this thesis, different cardiovascular biomarkers were studied in various clinical settings. The first part focuses on troponin elevation after noncardiac surgery, also called postoperative myocardial injury. Effective prevention and treatment options for postoperative myocardial injury are currently lacking. It is therefore crucial to acquire more knowledge about the underlying mechanisms of postoperative myocardial injury in order to improve the management and ultimately the prognosis of these patients. The second part of this thesis addresses the role of extracellular vesicles in cardiovascular disease. Extracellular vesicles (EVs) are small double membrane vesicles which are important in the communication between cells. Because EVs contain valuable information from the cells of origin, they can contribute to knowledge on the underlying pathophysiology of cardiovascular diseases. We found that EV proteins may be involved in the anticoagulant effects of statin therapy and in the combined organ failure of the cardiorenal syndrome. In the final part we describe some important lessons learned from conducting a clinical multicenter study on the aetiology of postoperative myocardial injury. The inclusion of patients who recover from major surgery for this multidisciplinary study is difficult. However, acquiring more knowledge on the aetiology of postoperative myocardial injury is of outmost importance in order to improve the prognosis of these patients in the future. The use of new biomarkers, such as extracellular vesicle proteins, may be useful in this.