Toward Precision in Myocardial Injury Management: A Critical Synthesis and the C.A.L.I.B.R.A.T.E. Framework for...

Area of Science:

• Cardiology
• Biomarker Science
• Translational Medicine

Background:

• Cardiovascular diseases are a leading cause of mortality, demanding improved myocardial injury diagnosis and management.
• Current biomarker strategies face translational gaps between research and clinical application.
• Established and emerging biomarkers have limitations in specificity and clinical utility.

Purpose of the Study:

• To critically review the current landscape of myocardial injury biomarkers.
• To propose an integrative framework for biomarker interpretation in clinical practice.
• To address translational gaps in biomarker science for precision cardiology.

Main Methods:

• Comprehensive critical review of established and emerging cardiac biomarkers.
• Thematic synthesis to develop the C.A.L.I.B.R.A.T.E. framework.
• Analysis of biological confounders, etiology-specific challenges, and implementation barriers.

Main Results:

• High-sensitivity assays improve detection but reduce specificity due to chronic elevations.
• Emerging biomarkers offer prognostic value but lack therapeutic guidance and specificity.
• Etiology-specific conditions complicate isolated biomarker interpretation, highlighting the need for integrated approaches.

Conclusions:

• The C.A.L.I.B.R.A.T.E. framework integrates clinical context, assay characteristics, and patient factors for structured diagnostic reasoning.
• Future myocardial injury management requires a shift from isolated measurements to algorithm-driven, integrated interpretation.
• This framework advances precision cardiology by enabling context-dependent, multi-modal data synthesis for personalized diagnosis.