Serial measurements of protein and microRNA biomarkers to specify myocardial infarction subtypes

Christian Schulte, Bhawana Singh, Konstantinos Theofilatos, Nils A Sörensen, Jonas Lehmacher, Tau Hartikainen, Paul M Haller, Dirk Westermann, Tanja Zeller, Stefan Blankenberg, Johannes T Neumann, Manuel Mayr

Research output: Contribution to journalArticlepeer-review


While cardiac-specific troponin (cTn) allows for rapid diagnosis of acute type 1 myocardial infarction (T1MI), its performance to differentiate acute myocardial injury (AI) or type 2 myocardial infarction (T2MI) is limited. The objective was to combine biomarkers to improve discrimination of different myocardial infarction (MI) aetiologies. We determined levels of cardiac troponin T and I (cTnT, cTnI), cardiac myosin-binding protein C (cMyBP-C), NT-proBNP and ten miRNAs, known to be associated with cardiac pathology in a total of = 495 serial plasma samples at three time points (on admission, after 1 h and 3 h) from 57 NSTEMI (non-ST-elevation myocardial infarction), 18 AI, and 31 STEMI patients, as defined by fourth universal definition of MI (UDMI4) and 59 control individuals. We then applied linear mixed effects model to compare the kinetics of all molecules in these MI sub-types. Established (cTnT, cTnI) and novel (cMyBP-C) cardiac necrosis markers failed in differentiating T1MI vs T2MI at early time points. All cardiac necrosis markers were higher in T1MI than in T2MI at 3 h after admission. Muscle-enriched miRNAs (miR-1 and miR-133a) were correlated with cardiac necrosis protein markers and did not offer better discrimination. Established cardiac strain marker NT-proBNP differentiated AI and T1MI at all time points but failed to discriminate T2MI from T1MI. However, the combination of NT-proBNP and cTnT along with age returned an overall AUC of 0.76 [95 % CI 0.67-0.84] for differentiating T1MI, T2MI and AI. Rather than using single biomarkers of myocardial necrosis, a combination of clinical biomarkers for cardiac necrosis (troponin) and cardiac strain (NT-proBNP) might aid in differentiating T1MI, T2MI and AI. [Abstract copyright: © 2022 The Authors.]
Original languageEnglish
Pages (from-to)None
JournalJournal of molecular and cellular cardiology plus
Publication statusPublished - Sept 2022


  • Biomarkers
  • Acute injury
  • Cardiac myosin-binding protein C
  • Troponin
  • microRNA
  • NT-proBNP
  • Myocardial infarction type 2


Dive into the research topics of 'Serial measurements of protein and microRNA biomarkers to specify myocardial infarction subtypes'. Together they form a unique fingerprint.

Cite this