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Cardiac markers: present and future
1Department of Laboratory Medicine, University Hospital of Padua, Via Giustiniani, 2, I-35128 Padua, Italy.
Insights
Acute myocardial infarction is now common, but cardiac troponins significantly improve diagnosis and risk stratification for acute coronary syndromes. Myoglobin and troponin are key early and definitive cardiac markers.
Area of Science:
- Cardiology
- Laboratory Medicine
- Biochemistry
Background:
- Acute myocardial infarction (AMI) has shifted from rare to common in industrialized nations.
- Laboratory medicine is vital for understanding coronary ischemic disease, plaque rupture, and risk factors.
- Advances in biochemical markers have revolutionized AMI diagnosis and management.
Purpose of the Study:
- To highlight the impact of new biochemical markers, especially cardiac troponins, on diagnosing and managing acute coronary syndromes (ACS).
- To emphasize the role of myoglobin as an early marker and cardiac troponin (I or T) as a definitive marker for myocardial damage.
- To discuss future research directions in cardiac marker standardization, bedside testing, and thrombogenesis markers.
Main Methods:
- Review of advancements in laboratory medicine for coronary ischemic disease.
- Focus on the discovery and application of cardiac troponins as diagnostic and prognostic tools.
- Discussion of emerging markers for thrombogenesis and their role in atherosclerosis.
Main Results:
- Cardiac troponins offer high specificity for diagnosing myocardial damage, improving risk stratification and outcome prediction in ACS.
- A combination of an early marker (myoglobin) and a definitive marker (cardiac troponin) is recommended.
- New markers of thrombogenesis and insights from vascular biology are crucial for understanding atherosclerosis and plaque stability.
Conclusions:
- Cardiac troponins represent a significant advancement in diagnosing and managing acute coronary syndromes.
- Future research should focus on standardizing troponin assays, developing rapid tests, and integrating thrombogenesis markers.
- Laboratory tests, including biochemical, immunological, and coagulative markers, will enhance the diagnosis and therapy of ischemic coronary diseases.
Abstract:
In the early twentieth century, acute myocardial infarction secondary to acute thrombotic coronary occlusion was considered a rare, fatal condition. Acute myocardial infarction is now one of the most-commmon serious illnesses in the industrialized world. Laboratory medicine now plays a crucial role in identifying risk factors, early events, and conditions triggering plaque rupture in coronary ischemic disease. However, the greatest progress in laboratory research has resulted from the discovery of new and more-promising biochemical markers of myocardial damage. The discovery of cardiac troponins, in particular, has heralded a new age in the diagnosis and treatment or management of a broad spectrum of diseases, grouped together under the heading of acute coronary syndrome, and including stable and unstable angina, and non-Q wave infarction to Q-wave infarction. Cardiac troponins, which are selectively released by damaged myocardiocytes, have a specificity that has not only allowed an improvement in the diagnosis of acute cardiac ischemic disorders, but has also enabled us to make a more-reliable stratification of risk and prediction of outcome. It is generally agreed that two biochemical markers should be used: an early marker (and we recommed myoglobin for this) and a definitive marker, which is cardiac troponin (I or T). Future research is likely to include the standardization of methods for measuring current markers, troponin I in particular, the assessment of rapid bedside tests, and the investigation of the relationship between cardiac markers and emerging immunological and coagulation parameters. Thrombogenesis is now recognized as important in the final process of coronary atherosclerosis, and new markers of thrombogenesis should be used to evaluate the risk of plaque rupture and to monitor the outcome of thrombolytic therapy. Moreover, recent vascular biology studies have provided information on the developmental stages of atherosclerosis and emphasized the importance of the endothelium as a modulator of vascular reactivity, atherogenesis, and plaque stability. The different types of laboratory test (biochemical, immunological, and coagulative) now available, should soon allow improvement in the diagnosis and therapy of ischemic coronary diseases.