Biomarkers of Sudden Cardiac Death: From Troponins to Circulating microRNAs

Abstract

Sudden cardiac death (SCD) remains a leading cause of mortality worldwide, often striking without warning in seemingly healthy individuals. The limitations of traditional risk stratification models and established biomarkers like cardiac troponins (cTn) necessitate the exploration of novel, more predictive tools. This review addresses the critical need to synthesize recent advancements in biomarker research to improve early detection and risk assessment for SCD. This review elucidates the evolving role of high-sensitivity cTn assays (hs-cTn) in detecting subclinical myocardial injury and their power in SCD prediction. We explore the considerable promise of circulating microRNAs (miRNAs) as stable, tissue-specific biomarkers that offer insights into pathophysiological processes preceding electrical instability. Furthermore, we examine the prognostic value of other emerging markets, including inflammatory cytokines, growth differentiation factor-15 (GDF-15), and perilipin-5, which reflect diverse pathways like inflammation, fibrosis, and metabolic stress. The significant synergy achieved by combining multiple biomarkers into integrated panels is highlighted as a key strategy for enhancing predictive accuracy. Finally, we cover technological innovations in biosensing that are paving the way for rapid, point-of-care detection of these biomarkers. Future research must prioritize large-scale, multicenter prospective studies to validate the clinical utility of novel biomarker panels. Efforts should also focus on standardizing detection assays and integrating biomarker data with genetic, clinical, and imaging markers using artificial intelligence. Ultimately, overcoming these challenges is essential for translating these advancements into personalized preventive strategies and reducing the global burden of SCD.