Elsevier

American Heart Journal

Volume 160, Issue 4, October 2010, Pages 583-594
American Heart Journal

Progress in Cardiology
Novel biomarkers in cardiovascular disease: Update 2010

https://doi.org/10.1016/j.ahj.2010.06.010Get rights and content

The rapid evaluation of patients presenting with symptoms suggestive of an acute coronary syndrome is of great clinical relevance. Biomarkers have become increasingly important in this setting to supplement electrocardiographic findings and patient history because one or both can be misleading. Today, cardiac troponin is still the only marker used routinely in this setting due to its myocardial tissue specificity and sensitivity, as well as its established usefulness for therapeutic decision making. However, even current generation troponin assays have certain limitations such as insufficient sensitivity for diagnosing unstable angina. Novel high-sensitivity assays for cardiac troponin have the potential to overcome these limitations. Further studies are needed to answer some critical questions regarding the best cutoffs for diagnosis and risk assessment and the optimal work-up for rule-out of acute myocardial infarction. Other nonmyocardial tissue-specific markers might help in this setting. Myeloperoxidase, copeptin, and growth differentiation factor 15 reflect different aspects of the development of atherosclerosis or acute ischemia. Each has demonstrated impact in risk stratification of acute coronary syndromes. Limited data also show that copeptin may, when used together with cardiac troponin, improve the sensitivity for diagnosing acute myocardial infarction, and growth differentiation factor 15 may help in selection of patients that benefit from invasive therapy. Further evaluation is needed before these markers can be adopted routinely in clinical practice.

Section snippets

Myocardial tissue specific markers

Despite the development of many markers associated with myocardial ischemia and injury, cardiac troponin is still the preferred marker in this category due to its myocardial tissue specificity and related sensitivity as well as its established usefulness for therapeutic decision making.3, 7, 20 However, an important limitation of prior generation assays was their low sensitivity within the first hours of AMI.3, 7, 21 Moreover, even current-generation assays do not distinguish between unstable

Nonmyocardial tissue-specific markers

Within the last decade a broad range of blood markers associated with an increased risk for death and cardiovascular endpoints have been identified (Table II).15, 52 Adding to markers of cell necrosis are markers of ischemia, inflammation, plaque destabilization or rupture, myocardial dysfunction, and stress. As shown in Table II, most of these markers have demonstrated at least some prognostic value. However, the number of markers with a diagnostic impact or important clinical implications

Perspective

The accuracy of the initial evaluation of patients presenting with symptoms suggestive for ACS can be associated with substantial clinical and economic consequences.92, 93 Biomarkers have become increasingly important in this setting to supplement electrocardiographic findings and patient history, since one or both can be misleading.3, 7 Due to limitations of current assays, the diagnosis of AMI cannot be excluded in a large proportion of patients at time of presentation, which can lead to

Disclosures

Conflict of interest: The TIMI Study Group has received significant research grant support from Accumetrics, Astra-Zeneca, Bayer Healthcare, Beckman Coulter, Biosite, BRAHMS, Bristol-Myers Squibb, CV Therapeutics, Daichii Sankyo Ltd, Eli Lilly and Co, GlaxoSmithKline, Merck and Company, Nanosphere, Novartis Pharmaceuticals, Ortho-Clinical Diagnostics, Pfizer, Roche Diagnostics, Sanofi-Aventis, Sanofi-Synthelabo, Schering-Plough, Siemens, and Singulex. Dr Hochholzer reports research grant

Acknowledgements

Dr. Hochholzer was supported by the German Heart Foundation.

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