The Role of High-Sensitivity Cardiac Troponin and Ischemia-Modified Albumin in Patients with Lower Extremity Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a growing global health concern associated with substantial morbidity, mortality, and healthcare costs. Prognostic stratification is currently based largely on clinical presentation, but patients with similar symptoms can have heterogeneous outcomes. Reliable biomarkers could improve the risk assessment of PAD patients and enable individualized patient management. High-sensitivity cardiac troponins (hs-cTn) and ischemia-modified albumin (IMA) have emerged as promising candidates. Hs-cTn appears to correlate with PAD severity and predict major adverse limb and cardiovascular events, likely reflecting subclinical myocardial injury in this patient population. Less extensively studied, IMA reflects oxidative stress, acidosis, and free radical activity. Its levels also seem to correlate with PAD severity, increasing with more advanced PAD. Notably, patients with advanced PAD but undetectable levels of biomarkers might have prognoses similar to those with milder disease, suggesting potential incremental prognostic value over clinical assessment. Despite these associations, the current applicability of hs-cTn and IMA remains limited by heterogeneous cut-off definitions and the absence of randomized controlled trials in the PAD population. Standardizing biomarker thresholds and prospective validation are crucial before integrating them into clinical practice. Both hs-cTn and IMA hold promise as tools for refined risk stratification in PAD, warranting further research.