Featured Research

from universities, journals, and other organizations

Biomarkers For Ischaemia And Necrosis - Simple Blood Tests To Detect Myocardial Infarction

Date:
September 2, 2008
Source:
European Society of Cardiology (ESC)
Summary:
Myocardial infarction is the major cause of death worldwide. With effective treatment within our grasp, accurate and rapid diagnosis is of major medical and economic importance. With the development of sensitive trials depicting either cardiac troponin I or cardiac troponin T, the only current biomarkers thought to be unique to the heart, the diagnosis of myocardial infarction has been revolutionized.

Myocardial infarction is the major cause of death worldwide. With effective treatment within our grasp, accurate and rapid diagnosis is of major medical and economic importance.

With the development of sensitive trials depicting either cardiac troponin I or cardiac troponin T, the only current biomarkers thought to be unique to the heart, the diagnosis of myocardial infarction has been revolutionised. In a patient presenting with chest pain, a rise in cardiac troponin has become a mandatory feature for the clinical diagnosis of myocardial infarction.

Cardiac troponins are our current gold standard for the detection of myocardial necrosis. The more sensitive the cardiac troponin essay used, the smaller the number of dying myocardial cells necessary for this signal to be detected. This has enabled us to detect high risk acute coronary syndrome patients with only minor myocardial damage. Unfortunately, current cardiac troponin essays have one major limitation in common with their predecessor (CKMB): it takes three to four hours after symptom onset until cardiac troponin becomes detectable.

Ongoing large clinical multicenter studies, including the Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE), are assessing whether novel cardiac troponin assays with even higher sensitivity or other biomarkers reflecting different pathophysiological processes such as, for example, copeptin (reflecting endogenuous stress) or myeloperoxidase (reflecting plaque instability and inflammation) will significantly shorten the “troponin-blind” period. Obviously, this would constitute a major medical and economic improvement in clinical practice.

However, the development of high sensitivity cardiac troponin assays also poses dilemmas: First, many physicians are reluctant to use the term “myocardial infarction” in patients with unstable coronary artery disease and tiny elevations of cardiac troponin. As these patients still seem to be at increased risk of death as compared to patients without detectable cardiac troponin levels, the current ESC/AHA/ACC guidelines encourage us to do so. Second, elevations in cardiac troponin I and T reflect myocardial injury, but do not indicate its mechanism.

Myocardial infarction can only be diagnosed when cardiac troponin I or T are increased in the clinical setting of myocardial ischemia – this means the myocardial cells suffer from a lack of oxygen and are “suffocating” due to reduced oxygen supply usually related to a clot in the coronary arteries or less commonly due to other causes of decreased supply such as coronary spasm or hypotension or due to increased oxygen demand such as septic shock.

The presenter, Professor C Mueller of the University Hospital Basel, said "As we currently lack a biomarker that reliably detects clot formation in the coronary arteries, we are left with our basic clinical tools, including patient history, to differentiate myocardial infarction from other causes of myocardial injury. Third, once a diagnostic test is declared “gold standard”, it becomes virtually impossible to rule out definitely false positive test results. This is currently the case with cardiac troponins. We strongly believe that the heart is invariably the exclusive source of cardiac troponin elevations, regardless of the specific patient conditions. However, as both the ECG and imaging techniques have far lower sensitivity to myocardial necrosis than cardiac troponin, scientific proof cannot be provided.

He continued, "In clinical practice we currently do not have a validated biomarker to assess myocardial ischemia. Cardiac troponins are blind for ischemia without necrosis. In both patients with myocardial ischemia at rest (unstable coronary artery disease) and exercise-induced myocardial ischemia (stable coronary artery disease) elevated B-type natriuretic peptides are associated with the presence of myocardial ischemia. However, the accuracy of B-type natriuretic peptides does not seem to be high enough for use in clinical practice. The ability to identify a patient at risk of myocardial cell death, before it actually occurs, is still a major unmet clinical need."

This material was presented by Professor C Mueller at the ESC Congress 2008 conference organized by the European Society of Cardiology (ESC) on September 2, 2008.


Story Source:

The above story is based on materials provided by European Society of Cardiology (ESC). Note: Materials may be edited for content and length.


Cite This Page:

European Society of Cardiology (ESC). "Biomarkers For Ischaemia And Necrosis - Simple Blood Tests To Detect Myocardial Infarction." ScienceDaily. ScienceDaily, 2 September 2008. <www.sciencedaily.com/releases/2008/09/080902075546.htm>.
European Society of Cardiology (ESC). (2008, September 2). Biomarkers For Ischaemia And Necrosis - Simple Blood Tests To Detect Myocardial Infarction. ScienceDaily. Retrieved August 30, 2014 from www.sciencedaily.com/releases/2008/09/080902075546.htm
European Society of Cardiology (ESC). "Biomarkers For Ischaemia And Necrosis - Simple Blood Tests To Detect Myocardial Infarction." ScienceDaily. www.sciencedaily.com/releases/2008/09/080902075546.htm (accessed August 30, 2014).

Share This




More Health & Medicine News

Saturday, August 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com
Liberia Continues Fight Against Ebola

Liberia Continues Fight Against Ebola

AFP (Aug. 30, 2014) Authorities in Liberia try to stem the spread of the Ebola epidemic by raising awareness and setting up sanitation units for people to wash their hands. Duration: 00:41 Video provided by AFP
Powered by NewsLook.com
California Passes 'yes-Means-Yes' Campus Sexual Assault Bill

California Passes 'yes-Means-Yes' Campus Sexual Assault Bill

Reuters - US Online Video (Aug. 30, 2014) California lawmakers pass a bill requiring universities to adopt "affirmative consent" language in their definitions of consensual sex, part of a nationwide drive to curb sexual assault on campuses. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
3 Things To Know About The Ebola Outbreak's Progression

3 Things To Know About The Ebola Outbreak's Progression

Newsy (Aug. 29, 2014) Here are three things you need to know about the deadly Ebola outbreak's progression this week. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins