Emerging Biomarkers of Myocardial Ischemia

  • Jesse E. Adams
Part of the Contemporary Cardiology book series (CONCARD)


Myocardial ischemia has a complex pathophysiology and can manifest with a multitude of clinical presentations, including without symptoms. Patients who present to the emergency department with a complaint of chest pain therefore require substantial diagnostic effort to determine whether their symptoms are related to acute myocardial ischemia. Present diagnostic approaches are typically protocol driven and include serial electrocardiograms and biomarkers obtained over an 8- to 12-h period for the detection of myocardial necrosis. This paradigm is reasonably effective in identifying patients who have acute coronary syndrome, especially when there is associated myocardial necrosis, but it offers only modest sensitivity and relies heavily on biomarkers that are increased only in the presence of irreversible myocardial injury (i.e., necrosis). For this reason, there has been intense research and clinical interest in the development of sensitive biomarkers of myocardial ischemia that are not dependent on the presence of myocardial necrosis. Markers investigated for this purpose include ultrasensitive troponin, ischemi-modified albumin, sCD40L, myeloperoxidase, glutathione peroxidase, nourins, unbound free fatty acid, and whole-blood choline. Despite the emergence of these candidate markers of ischemia, currently there is not sufficient evidence to recommend widespread adoption of any of them into clinical practice.

Key Words

Ischemia unstable angina biomarkers myocardial infarction prognosis 


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Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Jesse E. Adams
    • 1
  1. 1.Medical Center CardiologistsJewish Hospital Heart and Lung InstituteLouisville

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