Progress in CardiologyNovel biomarkers in cardiovascular disease: Update 2010
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.
References (97)
- et al.
Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care
Lancet
(1997) - et al.
Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials
Am Heart J
(2009) Cardiovascular biomarkers: the state of the art in 2006
Clin Chim Acta
(2007)- et al.
Biomarkers in acute cardiac disease: the present and the future
J Am Coll Cardiol
(2006) - et al.
Troponin T levels and risk of 30-day outcomes in patients with the acute coronary syndrome: prospective verification in the GUSTO-IV trial
Am J Med
(2003) - et al.
Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I access prototype assay and the impact on the diagnosis of myocardial ischemia
J Am Coll Cardiol
(2009) - et al.
Detection of myocardial injury in patients with unstable angina using a novel nanoparticle cardiac troponin I assay: observations from the PROTECT-TIMI 30 Trial
Am Heart J
(2009) - et al.
The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testing
Am Heart J
(2008) - et al.
Short periods of regional ischaemia and reperfusion provoke release of troponin I from the human hearts
Clin Chim Acta
(1999) - et al.
Intracellular compartmentation of troponin T: release kinetics after global ischemia and calcium paradox in the isolated perfused rat heart
J Mol Cell Cardiol
(1995)
Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis?
Clin Chim Acta
High-sensitive cardiac troponin I (hs-cTnI) values in patients with stable cardiovascular disease: an initial foray
Clin Chim Acta
New definition of myocardial infarction: impact on long-term mortality
Am J Med
Impact of the recommendations for the redefinition of myocardial infarction on diagnosis and prognosis in an unselected United Kingdom cohort with suspected cardiac chest pain
Am J Cardiol
Unsatisfactory redefinition of myocardial infarction
Lancet
Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I
J Am Coll Cardiol
Macrophage myeloperoxidase regulation by granulocyte macrophage colony-stimulating factor in human atherosclerosis and implications in acute coronary syndromes
Am J Pathol
Serum myeloperoxidase levels are associated with the future risk of coronary artery disease in apparently healthy individuals: the EPIC-Norfolk Prospective Population Study
J Am Coll Cardiol
Plasma concentrations of myeloperoxidase predict mortality after myocardial infarction
J Am Coll Cardiol
Copeptin, a stable peptide derived from the vasopressin precursor, is elevated in serum of sepsis patients
Peptides
Comparison of copeptin, B-type natriuretic peptide, and amino-terminal pro-B-type natriuretic peptide in patients with chronic heart failure: prediction of death at different stages of the disease
J Am Coll Cardiol
Incremental value of copeptin for rapid rule out of acute myocardial infarction
J Am Coll Cardiol
Copeptin improves early diagnosis of acute myocardial infarction
J Am Coll Cardiol
Mechanisms of TGF-beta signaling from cell membrane to the nucleus
Cell
The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis
J Am Coll Cardiol
Use of the combination of myoglobin and CK-MB mass for the rapid diagnosis of acute myocardial infarction
Am J Emerg Med
Measurement of prostate-specific antigen in serum as a screening test for prostate cancer
N Engl J Med
Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure
N Engl J Med
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction
Circulation
Tests of glycemia in diabetes
Diabetes Care
National Academy of Clinical Biochemistry Laboratory Medicine Practice guidelines for utilization of biochemical markers in acute coronary syndromes and heart failure
Clin Chem
National Academy of Clinical Biochemistry Laboratory Medicine Practice guidelines: emerging biomarkers for primary prevention of cardiovascular disease
Clin Chem
Universal definition of myocardial infarction
Circulation
Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea
N Engl J Med
C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women
N Engl J Med
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein
N Engl J Med
Quantitative plasma D-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism
Jama
Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis
N Engl J Med
Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome
Clin Chem
Pathophysiology of coronary artery disease
Circulation
Benchmarks for the assessment of novel cardiovascular biomarkers
Circulation
National Academy of Clinical Biochemistry Laboratory Medicine Practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes
Circulation
Assessing the requirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies
Clin Chem
The search for a biomarker of cardiac ischemia
Clin Chem
Direct hospital costs of chest pain patients attending the emergency department: a retrospective study
BMC Emerg Med
A new season for cardiac troponin assays: it's time to keep a scorecard
Clin Chem
National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes
Clin Chem
Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non–ST elevation myocardial infarction: results from a randomized trial
Jama
Cited by (129)
Postmortem biochemistry in deaths from ischemic heart disease
2023, Journal of Forensic and Legal MedicineBiomarker-based risk model to predict cardiovascular events in patients with acute coronary syndromes – Results from BIPass registry
2022, The Lancet Regional Health - Western PacificDistribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease
2021, Endocrinologia, Diabetes y NutricionRecent advances in cardiac biomarkers detection: From commercial devices to emerging technologies
2021, Journal of Pharmaceutical and Biomedical Analysis