What is the clinical evidence from this study?

Study design: Review. Population: Myocardial injury. Intervention: C.A.L.I.B.R.A.T.E. framework.

What question did this study set out to answer?

The aim is to synthesize current biomarker knowledge and propose a framework for integrating these into clinical practice for managing myocardial injury.

June 12, 2026Open Access

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

Resultado clave

The C.A.L.I.B.R.A.T.E. framework was developed to structure biomarker integration and provide a pathway for personalized diagnostic reasoning in myocardial injury management.

Puntos clave

The aim is to synthesize current biomarker knowledge and propose a framework for integrating these into clinical practice for managing myocardial injury.
Conducted a comprehensive critical review of established and emerging biomarkers.
Developed the C.A.L.I.B.R.A.T.E. framework to address gaps between biomarker science and clinical implementation.
Analyzed biological confounders and etiology-specific challenges in clinical contexts.
Biomarkers like cardiac troponins and natriuretic peptides improve detection but complicate acute diagnosis due to chronic elevations.
Emerging biomarkers such as sST2 and galectin-3 provide prognostic insights but lack therapeutic specificity.
The C.A.L.I.B.R.A.T.E. framework offers a structured approach to integrating multiple biomarker data for personalized diagnostics.

PICO

Población

Myocardial injury

Intervención / comparador

C.A.L.I.B.R.A.T.E. framework

Resumen

Cardiovascular diseases remain the leading cause of global mortality, necessitating precise strategies for diagnosing and managing myocardial injury. This review critically synthesizes the current biomarker landscape and proposes an integrative framework to address the significant translational gaps between biomarker science and clinical practice. We conducted a comprehensive critical review, analyzing established and emerging biomarkers, including cardiac troponins, natriuretic peptides, and inflammatory and fibrotic markers, within the context of biological confounders, etiology-specific challenges, and clinical implementation barriers. Through thematic synthesis, we developed the novel C.A.L.I.B.R.A.T.E. framework to structure biomarker integration. While high-sensitivity assays have improved detection, they reveal chronic elevations in conditions like renal dysfunction, aging, and heart failure, reducing specificity and complicating acute diagnosis. Emerging biomarkers (eg, sST2, galectin-3) offer prognostic insight but lack therapeutic guidance and specificity. Etiology-specific puzzles (eg, myocarditis, COVID-19, MINOCA) highlight the limitations of isolated biomarker interpretation. The C.A.L.I.B.R.A.T.E. framework addresses these gaps by integrating Clinical context, Assay characteristics, Likelihood, Injury mechanism, Biomarker profiles, Rule-out/in thresholds, Adjunctive tests, Time kinetics, and Etiologies & comorbidities. The future of myocardial injury management depends on shifting from isolated biomarker measurement to integrated, algorithm-driven interpretation. The C.A.L.I.B.R.A.T.E. framework provides a structured pathway for personalized diagnostic reasoning, bridging the translational chasm and advancing precision cardiology through context-dependent, multi-modal data synthesis.

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