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Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury
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Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 1456

Special Issue Editor

Dr. Beatriz Martín-Carro

E-Mail Website
Guest Editor
1. Department of Cardiology, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
2. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, 28029 Madrid, Spain
Interests: cardiovascular diseases; chronic kidney disease; mortality; biomarker

Special Issue Information

Dear Colleagues,

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide and continue to pose a major challenge for healthcare systems. Despite advances in diagnosis and therapy, the early identification of individuals at high risk and the precise characterization of underlying pathophysiological mechanisms remain unmet clinical needs. Conventional risk scores based on traditional factors account for only a fraction of the variability in outcomes. The discovery and validation of novel molecular and circulating biomarkers offer a promising opportunity to enhance early detection, refine risk stratification, and support personalized prevention and treatment strategies. 

Well-established biomarkers routinely integrated into clinical practice, such as high-sensitivity cardiac troponins (hs-cTn), N-terminal pro-Brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) provide accurate measures of myocardial injury, hemodynamic stress and systemic inflammation, respectively. In parallel, emerging biomarkers -including growth differentiation factor 15 (GDF-15), soluble ST2, galectin-3, circulating microRNA signatures (e.g., miR-1, miR-133a, miR-208, miR-499), and metabolites such as trimethylamine-N-oxide (TMAO)- offer additional mechanistic insights into fibroinflammatory remodelling, endothelial dysfunction, metabolic dysregulation, and oxidative stress. These biomarkers highlight key molecular pathways, including NF-κB-driven inflammation, TGF-β-mediated fibrosis, mitochondrial dysfunction, dysregulated calcium handling, and programmed cell death. 

This Special Issue aims to bring together basic, translational, and clinical research focused on emerging biomarkers of cardiovascular burden and myocardial injury, with particular focus on mechanistic insights, prognostic value, and clinical applicability. 

Dr. Beatriz Martín-Carro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Molecular Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. There is an Article Processing Charge (APC) for publication in this open access journal. For details about the APC please see here. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiovascular disease
  • myocardial injury
  • heart failure
  • biomarkers
  • risk stratification

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Related Special Issue

Published Papers (3 papers)

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Research

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19 pages, 1633 KB  
Article
Growth Differentiation Factor 15 as a Biomarker of Cardiovascular Burden and Mortality in a Population-Based Cohort
by Beatriz Martín-Carro, Leticia Nieto-García, Clara Sánchez-Pablo, Alfonso Romero, Candelas Pérez del Villar, José Carlos Moyano-Maza, José María de Dios, David Cembrero-Fuciños, Estefanía Iglesias-Colino, Paz Muriel, Sara Cascón, Amalia Martín-Gallego, Baltasara Blázquez, Inmaculada Santolino, Lydia González-González, María Concepción Ledesma, Javier Maillo-Seco, Jesús Rodríguez-Nieto, Luis M. Rincón, María Isidoro-García and Pedro L. Sánchezadd Show full author list remove Hide full author list
Int. J. Mol. Sci. 2026, 27(7), 3078; https://doi.org/10.3390/ijms27073078 - 27 Mar 2026
Viewed by 482
Abstract
Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine strongly associated with aging, multimorbidity, and cardiovascular disease. Although prior studies have established its prognostic value in high-risk populations, its role in the general population remains less defined. The aim of this study was [...] Read more.
Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine strongly associated with aging, multimorbidity, and cardiovascular disease. Although prior studies have established its prognostic value in high-risk populations, its role in the general population remains less defined. The aim of this study was to determine if there is an association between plasma GDF15 levels, heart disease and mortality in a representative population-based cohort. We analyzed 1532 participants (mean age 55 years; 54.6% women) with available baseline plasma GDF15 concentrations. Participants were stratified according to an optimal cutoff of 1081 pg/mL, derived from ROC curve analysis for mortality. Associations with prevalent heart disease were assessed using multivariable logistic regression models adjusted for cardiovascular risk factors and NT-proBNP. Mortality was analyzed using Cox proportional hazards models, with model performance evaluated by C-index and time-dependent ROC curves. Individuals with GDF15 > 1081 pg/mL were older and exhibited a more adverse cardiometabolic profile with higher prevalence of comorbidities. Elevated GDF15 was independently associated with ischemic cardiomyopathy (OR 3.34, 95% CI: 1.38–8.11), particularly in men (OR 4.26, 95% CI: 1.40–12.96), but not in women. No independent associations were observed with arrhythmias, valvulopathy, or heart failure after adjustment for NT-proBNP. During a median follow-up of 6.2 years, 51 deaths occurred. Elevated GDF15 independently predicted all-cause mortality (HR 2.47, 95% CI: 1.19–5.13), though the effect was attenuated after adjustment for NT-proBNP. GDF15 improved model discrimination (ΔC-index = +0.01; LRT p = 0.011) and showed robust time-dependent predictive ability, with AUCs of 0.76, 0.82, and 0.85 at 2, 4, and 6 years, respectively. In this population-based cohort, elevated GDF15 identified individuals with an adverse health profile, was independently associated with ischemic cardiomyopathy in men, and predicted mortality. Although its incremental predictive value over NT-proBNP was modest, GDF15 could provide complementary biological information and may enhance multimarker strategies for cardiovascular risk stratification in the general population. Full article
(This article belongs to the Special Issue Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury)
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Review

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21 pages, 1490 KB  
Review
Predictive Biomarkers for Coronary Collateral Circulation Development After Myocardial Infarction
by Andrei Constantinescu, Miruna Mihaela Micheu, Elisa Anamaria Liehn and Alexandru Scafa Udrişte
Int. J. Mol. Sci. 2026, 27(8), 3671; https://doi.org/10.3390/ijms27083671 - 20 Apr 2026
Viewed by 292
Abstract
Myocardial infarction remains a leading cause of mortality worldwide as the most severe clinical presentation of coronary artery disease, with an increasing trend in young adults. In the early phase of myocardial infarction, the mean blood pressure regulates the pressure distal to the [...] Read more.
Myocardial infarction remains a leading cause of mortality worldwide as the most severe clinical presentation of coronary artery disease, with an increasing trend in young adults. In the early phase of myocardial infarction, the mean blood pressure regulates the pressure distal to the occluded artery in the presence of well-developed collateral coronary circulation. Hypotensive medication administered after the myocardial infarction could compromise collateral recruitment and exacerbate myocardial ischemia. Collateral coronary circulation develops through angiogenic processes as a network of small blood vessels. After the myocardial infarction, the collateral arteries open and begin a process of arteriogenesis in order to mature into functional arteries. Although there are several well-known biochemical and molecular biomarkers for both myocardial infarction and angiogenesis, we need to associate these with arteriogenesis biomarkers in order to be able to fully determine the level of collateral coronary circulation development after myocardial infarction. In this review, we summarize some of the most important biomarkers that could provide insight into the collateral coronary arteriogenesis process. Our aim is to identify specific biomarkers that can be identified in the early processes of arteriogenesis after the myocardial event in order to quickly determine the best therapeutic strategy. Full article
(This article belongs to the Special Issue Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury)
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28 pages, 2113 KB  
Review
The Prognostic Value of Pre-Procedural and Post-Procedural Inflammatory–Oxidative Stress Biomarkers in Acute Coronary Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
by Jonathan Samuel Matogu Tambunan, Citrawati Dyah Kencono Wungu, Hendri Susilo, Azizah Bonitha Zahrah Santoso, Anindita Azkia Fauzana, Pramudya Dhafa Hernandi, Albert Steven Purnama, Langgeng Agung Waskito, Indah Mohd Amin and Nando Reza Pratama
Int. J. Mol. Sci. 2026, 27(8), 3389; https://doi.org/10.3390/ijms27083389 - 9 Apr 2026
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Abstract
Acute coronary syndrome patients undergoing percutaneous coronary intervention remain at high risk for major adverse cardiovascular events (MACE: cardiovascular mortality, non-fatal myocardial infarction, and stroke). Inflammatory–oxidative stress biomarkers are potential prognostic tools; however, the influence of sampling timing—pre-procedural versus post-procedural—remains unclear. This meta-analysis [...] Read more.
Acute coronary syndrome patients undergoing percutaneous coronary intervention remain at high risk for major adverse cardiovascular events (MACE: cardiovascular mortality, non-fatal myocardial infarction, and stroke). Inflammatory–oxidative stress biomarkers are potential prognostic tools; however, the influence of sampling timing—pre-procedural versus post-procedural—remains unclear. This meta-analysis evaluated six biomarkers: sST2, GDF-15, OPG, sLOX-1, H-FABP, and Galectin-3. Pooled Hazard Ratios (HRs) for time-to-event outcomes and Standardized Mean Differences (SMDs) between event and non-event groups were synthesized using random-effects models involving 40 studies (18,933 patients). Elevated pre-procedural levels of sST2 (HR = 3.32, p < 0.0001), GDF-15 (HR = 3.00, p < 0.0001), sLOX-1 (HR = 2.61, p = 0.0023), and OPG (HR = 1.79, p = 0.0206) significantly predicted MACE. Notably, pre-PCI sST2 strongly predicted heart failure hospitalization (HR = 6.30, p < 0.0001). Additionally, pre-PCI H-FABP demonstrated a moderate significant effect on adverse outcomes (SMD = 0.67, p < 0.0001). While pre-PCI Galectin-3 was not significant, its post-procedural levels showed a large significant effect (SMD = 1.15, p < 0.0001). In conclusion, inflammatory and oxidative stress biomarkers, particularly sST2 and GDF-15, demonstrate consistent associations with adverse outcomes in ACS patients undergoing PCI, offering more reliable baseline risk stratification than post-procedural measurements. Full article
(This article belongs to the Special Issue Emerging Biomarkers in Cardiovascular Risk Assessment and Myocardial Injury)
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