Personalized medicine is partly based on biomarker-guided diagnostics, therapy and prognosis, which is becoming an unavoidable concept in modern cardiology. However, the clinical significance of single biomarker studies is rather limited. A promising novel approach involves combining multiple markers into a multiplex panel, which could refine the management of a particular patient with cardiovascular pathology. Two principally different assay formats have been developed to facilitate simultaneous quantification of multiple antigens: planar array assays and microbead assays. These approaches may help to better evaluate the complexity and dynamic nature of pathologic processes and offer substantial cost and sample savings compared with traditional enzyme-linked immunosorbent assay (ELISA) measurements. However, a multiplex multimarker approach cannot become a generally disseminated method until analytical problems are solved and further studies confirming improved clinical outcomes are accomplished. These drawbacks underlie the fact that a limited number of systematic studies are available regarding the use of a multiplex biomarker approach in cardiovascular medicine to date. Our perspective underscores the significant potential of the use of the multiplex approach in a wider conceptual framework under the close cooperation of clinical and experimental cardiologists, pathophysiologists and biochemists so that the personalized approach based on standardized multimarker testing may improve the management of various cardiovascular pathologies and become a ubiquitous partner of population-derived evidence-based medicine.

3rd Department of Internal Medicine Faculty of Medicine Comenius University Bratislava Slovak Republic

Department of Physiology Faculty of Medicine in Hradec Kralove Charles University Prague Hradec Kralove Czech Republic

Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of Sciences Bratislava Slovak Republic

Institute of Pathophysiology Faculty of Medicine Comenius University Bratislava Slovak Republic

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US President's Council of Advisors on Science and Technology (PCAST) Priorities for Personalized Medicine. Washington DC: Executive Office of the President of United States; 2008.

Johnson JA, Cavallari LH. Pharmacogenetics and cardiovascular disease – implication for personalized medicine. Pharmacol Rev. 2013;65:987–1009. doi: 10.1124/pr.112.007252. PubMed DOI PMC

Adamcova M, Lencova-Popelova O, Jirkovsky E, Mazurova Y, Palicka V, Simko F, et al. Experimental determination of diagnostic window of cardiac troponins in the development of chronic anthracycline cardiotoxicity and estimation of its predictive value. Int J Cardiol. 2015;201:358–67. doi: 10.1016/j.ijcard.2015.07.103. PubMed DOI

Adamcova M, Popelova-Lencova O, Jirkovsky E, Simko F, Gersl V, Sterba M. Cardiac troponins: Translational biomarkers in cardiology: Theory and practice of cardiac troponin high-sensitivity assays. Biofactors. 2016;42:133–48. PubMed

Taqui S, Daniels LB. Putting it into perspective: multimarker panels for cardiovascular disease risk assessment. Biomark Med. 2013;7:317–27. doi: 10.2217/bmm.13.15. PubMed DOI

Fu Q, Zhu J, Van Eyk JE. Comparison of multiplex immunoassay platforms. Clin Chem. 2010;56:314–8. doi: 10.1373/clinchem.2009.135087. PubMed DOI PMC

Adamcova M, Ruzickova S, Simko F. Multiplexed immunoassays for simultaneous quantification of cardiovascular biomarkers in the model of HG-nitro-L-arginine methylester (L-NAME) hypertensive rat. J Physiol Pharmacol. 2013;64:211–7. PubMed

Herman E, Knapton A, Zhang J, Estis J, Todd J, Lipshultz S. The utility of serum biomarkers to detect myocardial alterations induced by Imatinib in rats. Pharmacol Res Perspect. 2014;2:e00015. doi: 10.1002/prp2.15. PubMed DOI PMC

Vistnes M, Wæhre A, Nygard S, Sjaastad I, Andersson KB, Husberg C, et al. Circulating cytokine levels in mice with heart failure are etiology dependent. J Appl Physiol. 2010;108:1357–64. doi: 10.1152/japplphysiol.01084.2009. PubMed DOI

Lori LD, Maisel AS. Multiple marker approach to risk stratification in patients with stable coronary artery disease: to have or have not. Eur Heart J. 2010;31:2980–3. doi: 10.1093/eurheartj/ehq336. PubMed DOI

Blankenberg S, Zeller T, Saarela O, Havulinna AS, Kee F, Tunstall-Pedoe H, et al. Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: the Monica, Risk, Genetics, Archiving, and Monograph (MORGAM) biomarker project. Circulation. 2010;121:2388–97. doi: 10.1161/CIRCULATIONAHA.109.901413. PubMed DOI

Shah RU, Rumsfeld JS. Big data in cardiology. Eur Heart J. 2017;38:1865–7. doi: 10.1093/eurheartj/ehx284. PubMed DOI PMC

Halim SA, Neely ML, Pieper KS, Shah SH, Kraus WE, Hauser ER, et al. Simultaneous consideration of multiple candidate protein biomarkers for long-term risk for cardiovascular events. Circ Cardiovasc Genet. 2015;8:168–77. doi: 10.1161/CIRCGENETICS.113.000490. PubMed DOI PMC

Gupta DK, Wang TJ. Biomarker discovery: searching for quality in quantity. Circ Cardiovasc Genet. 2015;8:8–10. doi: 10.1161/CIRCGENETICS.115.000973. PubMed DOI

Gerstein HC, Paré G, McQueen MJ, Haenel H, Lee SF, Pogue J, et al. Outcome reduction with initial glargine intervention trial investigators: Identifying novel biomarkers for cardiovascular events or death in people with dysglycemia. Circulation. 2015;132:2297–304. doi: 10.1161/CIRCULATIONAHA.115.015744. PubMed DOI

de Lemos JA, Rohatgi A, Ayers CR. Applying a big data approach to biomarker discovery: running before we walk? Circulation. 2015;132:2289–92. doi: 10.1161/CIRCULATIONAHA.115.019648. PubMed DOI

Vistnes M, Hoiseth AD, Rosjo H, Nygard S, Pettersen E, Soyseth V, et al. Lack of pro-inflammatory cytokine mobilization predicts poor prognosis in patients with acute heart failure. Cytokine. 2013;61:962–9. doi: 10.1016/j.cyto.2013.01.006. PubMed DOI

Tighe PJ, Ryder RR, Todd I, Fairclough LC. ELISA in the multiplex era : Potentials and pitfalls. Proteomics Clin Appl. 2015;9:406–22. doi: 10.1002/prca.201400130. PubMed DOI PMC