Emerging Biomarkers of Myocardial Ischemia
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 WordsIschemia unstable angina biomarkers myocardial infarction prognosis
Unable to display preview. Download preview PDF.
- 2.Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-ST segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol 2000;36:970–1062.CrossRefPubMedGoogle Scholar
- 5.Gerstenblith G. Derangements in cardiac metabolism in the ischemic state and consequences of reperfusion. Adv Stud Med 2004;4(6B):S464–S471.Google Scholar
- 8.McDonough JL, Labugger R, Van Eyk JE. Prepare to meet your markers: making the most of troponin degradation. In: Adams JE, Apple FS, Jaffe AS, Wu AHB, eds. Markers in Cardiology: Current and Future Clinical Applications. Futura, Armonk, NJ, 2001, pp. 13–21.Google Scholar
- 20.Cosin-Sales J, Christiansen M, Kaminski P, et al. Pregnancy-associated plasma protein A and its endogenous inhibitor, the proform of eosinophil major basic protein (proMBP) are related to complex stenosis morphology in patients with stable angina pectoris. Circulation 2004;109:1724–1728.CrossRefPubMedGoogle Scholar
- 35.Kleinfeld AM, Kleinfeld KJ, Adams JE. Serum levels of unbound free fatty acids reveal high sensitivity for early detection of acute myocardial infarction in patient samples from the TIMI II trial. J Am Coll Cardiol 2002;39(Suppl 2):413A.Google Scholar
- 37.Elgebaly SA, Kozol RA, Masetti P, Bohr M, Lennan C. Release of neutrophil chemotactic factors from ischemic myocardial tissues. Surg Forum 1987;38:276–279.Google Scholar
- 39.Elgebaly SA, Mauri F, Azrin M, et al. Cardiac-derived neutrophil chemotactic factor: an early diagnostic marker for cardiac patients. 2004; manuscript in preparation.Google Scholar