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The Bergen Atherosclerosis and Cardiac bIOmarker (BACIO) Study
Cardiac troponins are markers of cardiac stress, injury and necrosis. Circulating concentrations increase after ischemic injury, but may also rise acutely after cardiotoxic injury, traumatic injury or after strenuous physical activity.
Chronic, low-grade, elevation in troponin concentration is associated with structural heart disease and signals increased risk of heart failure and cardiovascular death. The determinants, prognostic value and treatment options of chronic elevation of cardiac troponins (i.e. stable concentrations > 99th percentile of the assay) and other novel biomarkers in chest pain patients ruled out for acute myocardial infarction (AMI), remain poorly defined.
The BACIO study has recruited approximately 1100 consecutive chest pain patients initially ruled out for AMI with the overall aim to assess 1) the diagnostic and prognostic accuracy of established and novel cardiovascular biomarkers using cardiac imaging and clinical end-points as the outcome measures; 2) to identify determinants of chronic elevation of cardiac troponins and other novel biomarkers; 3) to describe relation between novel biomarkers related to pathophysiological mechanisms for atherosclerosis and traditional inflammatory and myocardial necrosis markers.
The BACIO study is a prospective observational study that will benefit from the imaging research infrastructures located at the Department of Heart Disease and contribute to further development of the dedicated facilities. All patients will undergo diagnostic imaging (coronary computer tomography angiography, CCTA) to determine the extent and severity of coronary artery disease (CAD). A panel of established and novel cardiac biomarkers will be analyzed and the diagnosticaccuracy of these to identify CAD will be assessed. A subset of patients (n=200) will undergo cardiac magnetic resonance imaging (CMRi) for assessment of structural heart disease. Furthermore, the short-term and long-term prognostic information provided by the biomarkers, as well as associations with LV systolic function and mass (i.e. in the sub-study), will be evaluated.
A translational part of the study will measure Neutrophil Extracellular Traps (NETs). These are novel biomarkers important for the inflammation and immune responses that could be key factors in the pathophysiologic development of atherosclerosis. In our study we will relate these markers to atherosclerosis, structural myocardial disease and prognosis.
The project is funded by the Trond Mohn Foundation (TMF), Haukeland University Hospital and the Western Norway Regional Health Authority
Torbjørn Omland (PI), MD, PhD. University of Oslo and Akershus University Hospital
Kristin M Aakre (co-PI), MD, PhD. Haukeland University Hospital and University of Bergen
Eva Ringdal Pedersen (PI of the sub-study Vector), MD, PhD. Haukeland University Hospital
Kjell Vikenes, MD, PhD. Haukeland University Hospital and University of Bergen
Iman Karaji, MD. Haukeland University Hospital
Gard MS Myrmel, MD. Haukeland University Hospital
Bjørn Tore Gjertsen, MD, PhD. Haukeland University Hospital and University of Bergen
Stein Erik Gullaksen, PhD. University of Bergen
Fred Apple, PhD, DABCC. University of Minnesota, School of Medicine and Hennepin County Medical Center
Nicolas Mills, MD, PhD. University of Edinburgh and Royal Infirmary of Edinburgh
Brendan Everett, MD, PhD. Brigham and Women's Hospital and Harvard Medical School
Steven Meex, MD, PhD. Maastricht University Medical Center and Maastricht University
Mikael Marber, MD, PhD. King's College London and St Thomas’ NHS Trust
Original articles
Growth differentiation factor 15: a prognostic marker in patients with acute chest pain without acute myocardial infarction. Gard MS Myrmel, Ole-Thomas Steiro, Hilde L Tjora, Jørund Langørgen, Rune Bjørneklett, Øyvind Skadberg, Vernon VS Bonarjee, Øistein R Mjelva, Eva KR Pedersen,Kjell Vikenes, Torbjørn Omland and Kristin M Aakre. Clin Chem. 2023 Jun 1;69(6):649-660.
Prognostic value of Growth Differentiation Factor - 15 three months after an acute chest pain admission. Gard Mikael Sæle Myrmel, Ole Thomas Steiro, Hilde Lunde Tjora, Jørund Langørgen, Rune Oskar Bjørneklett, Øyvind Skadberg, Vernon Vijay Singha Bonarjee, Øistein Rønneberg Mjelva, Eva Ringdal Pedersen, Kjell Vikenes, Torbjørn Omland, Kristin Moberg Aakre. Heart. 2024 Mar 12;110(7):508-516.
Sex-differences in the prognostic value of circulating biomarkers in patients presenting with acute chest pain. Gard Mikael Sæle Myrmel, Nasir Saeed, Ole Thomas Steiro, Hilde Lunde Tjora, Jørund Langørgen, Rune Oskar Bjørneklett, Øyvind Skadberg, Vernon Vijay Singha Bonarjee, Øistein Rønneberg Mjelva, Eva Ringdal Pedersen, Kjell Vikenes, Torbjørn Omland, Kristin Moberg Aakre. JACC Adv. 2025 Feb;4(2):101567.
Limited incremental value of growth differentiation factor 15 in the initial evaluation of low and intermediate risk acute chest pain patients. Karaji I, Steiro OT, Myrmel GM, Omland T, Tjora HL, Langørgen J, Bjørneklett R, Skadberg Ø, Bonarjee VV, Mjelva ØR, Collinson P, Vikenes K, Larsen TH, Aakre KM, Pedersen ER. Clin Biochem. 2025 Jun;137:110926.
Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled Trial. Thulin VIL, Jordalen SMF, Myrmel GMS, Lekven OC, Krishnapillai J, Steiro OT, Body R, Collinson P, Apple FS, Cullen L, Norekvål TM, Wisløff T, Vikenes K, Bjørneklett RO, Omland T, Aakre KM. Ann Emerg Med. 2025 Aug;86(2):124-135.
Diagnostic Accuracy of a Novel 0/1-H Algorithm Using Point-of-Care High-Sensitivity Troponin in the Emergency Department. Thulin VIL, Myrmel GMS, Collinson PO, Apple FS, Vikenes K, Bjørneklett RO, Omland T, Aakre KM. Clin Chem. 2025 Sep 3;71(9):1005-1008.
Review articles
Cardiac biomarkers and CT coronary angiography for the assessment of coronary heart disease. Gard Mikael Sæle Myrmel, Ryan Wereski, Iman Karaji, Nasir Saeed, Kristin Moberg Aakre, Nicholas L Mills, Eva Ringdal Pedersen. Clin Biochem. 2025 Jan;135:110857.
