Cardiac myosin‐binding protein C in the diagnosis and risk stratification of acute heart failure

Abstract

Aims Cardiac myosin‐binding protein C (cMyC) seems to be even more sensitive in the quantification of cardiomyocyte injury vs. high‐sensitivity cardiac troponin, and may therefore have diagnostic and prognostic utility. Methods and results In a prospective multicentre diagnostic study, cMyC, high‐sensitivity cardiac troponin T (hs‐cTnT), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) plasma concentrations were measured in blinded fashion in patients presenting to the emergency department with acute dyspnoea. Two independent cardiologists centrally adjudicated the final diagnosis. Diagnostic accuracy for acute heart failure (AHF) was quantified by the area under the receiver operating characteristic curve (AUC). All‐cause mortality within 360 days was the prognostic endpoint. Among 1083 patients eligible for diagnostic analysis, 51% had AHF. cMyC concentrations at presentation were higher among AHF patients vs. patients with other final diagnoses [72 (interquartile range, IQR 39–156) vs. 22 ng/L (IQR 12–42), P < 0.001)]. cMyC's AUC was high [0.81, 95% confidence interval (CI) 0.78–0.83], higher than hs‐cTnT's (0.79, 95% CI 0.76–0.82, P = 0.081) and lower than NT‐proBNP's (0.91, 95% CI 0.89–0.93, P < 0.001). Among 794 AHF patients eligible for prognostic analysis, 28% died within 360 days; cMyC plasma concentrations above the median indicated increased risk of death (hazard ratio 2.19, 95% CI 1.66–2.89; P < 0.001). cMyC's prognostic accuracy was comparable with NT‐proBNP's and hs‐cTnT's. cMyC did not independently predict all‐cause mortality when used in validated multivariable regression models. In novel multivariable regression models including medication, age, left ventricular ejection fraction, and discharge creatinine, cMyC remained an independent predictor of death and had no interactions with medical therapies at discharge. Conclusion Cardiac myosin‐binding protein C may aid physicians in the rapid triage of patients with suspected AHF.

Insights into the Novel Cardiac Biomarker in Acute Heart Failure: Mybp-C

“…In our study, MyBP-C showed positive correlations with established HF biomarkers (NT-proBNP and hs-TnI), which highlights its potential as an additional diagnostic tool in AHF, especially in cases where conventional biomarkers may not provide conclusive results. The relationship of MyBP-C with NT-proBNP and hs-TnI is supported by previous reports and is driven by the complex changes in AHF associated with cardiac injury, myocardial stretching, and cardiac pressure overload [39][40][41]. The diagnostic accuracy and prognostic value in AHF can be improved by a multimarker approach, which allows the evaluation of different pathophysiological pathways.…”

“…MyBP-C has been reported in many studies as a novel biomarker in myocardial infarction, which may help to quantify cardiomyocytes injury even more accurately than hs-TnI [35,36]. Also, due to its role in cardiac contraction and relaxation, dephosphorylation and subsequent release into the circulation was observed in patients with heart failure [37][38][39][40][41][42]. Furthermore, MyBP-C has emerged as a potential therapeutic target for the treatment of heart failure.…”

Cardiac myosin-binding protein C as a biomarker of acute myocardial infarction

“…3 (4) Despite cMyC having a sarcomeric location and kinetic profile that differs from cTnT/I, its concentration is similarly increased by chronic myocardial injury and acute (non-ischaemic) myocardial injury. 3,4 Based on these results the diagnostic performance of cMyC is similar to cTnT/I. Whilst this is a remarkable accomplishment, the question remains whether cMyC has sufficient distinctive advantage to possibly replace cTnT/I or add enough incremental value to be used in conjunction with cTnT/I?…”

May 2021 at a glance: focus on acute heart failure and heart failure with preserved ejection fraction

“…Organ injury may be a major mechanism of the deleterious effects of congestion in patients with acute HF 6 . Kozhuharov et al 9 . studied patients presenting to the emergency department with acute dyspnoea and showed that plasma levels of cardiac myosin‐binding protein C (cMyC), a marker of myocardial injury, were higher in those with acute HF and were a marker of increased risk of all‐cause mortality [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.66‐2.89; P < 0.001 for patients above median cMyC concentrations].…”