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A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Laboratory diagnostics of myocardial infarction--troponins and beyond
1Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Mainz, Mainz, Germany. karl.lackner@unimedizin-mainz.de
Insights
High-sensitive cardiac troponin assays (hs-cTn) are crucial for diagnosing myocardial infarction. While other biomarkers show limited added value, hs-cTn remains the most effective single marker for early detection.
Area of Science:
- Cardiology
- Biomarker Discovery
Background:
- Accurate diagnosis of acute coronary syndrome and myocardial infarction relies on cardiac biomarkers, particularly cardiac troponins (cTn).
- Early myocardial infarction diagnosis faced challenges with unsatisfactory sensitivity of traditional cTn assays, prompting research into alternative markers like myoglobin.
- The development of high-sensitive cardiac troponin (hs-cTn) assays necessitates re-evaluation of the utility of other diagnostic markers.
Purpose of the Study:
- To reassess the diagnostic value of alternative and additional biomarkers in the context of high-sensitive cardiac troponin (hs-cTn) assays for acute myocardial infarction.
- To evaluate if markers like myoglobin, heart-type fatty acid binding protein, copeptin, or plasma free fatty acids offer superior sensitivity or incremental diagnostic value compared to hs-cTn.
- To determine the necessity of further data for assessing the diagnostic improvement and superiority of these markers over hs-cTn protocols.
Main Methods:
- Review of current data on the diagnostic performance of various biomarkers for acute myocardial infarction.
- Comparison of the sensitivity and specificity of traditional markers (e.g., myoglobin) and novel markers (e.g., heart-type fatty acid binding protein, copeptin, plasma free fatty acids) against hs-cTn assays.
- Assessment of the incremental diagnostic and negative predictive value of combining hs-cTn with other markers on admission.
Main Results:
- No single biomarker currently surpasses hs-cTn for diagnosing acute myocardial infarction.
- The previously held notion of myoglobin's superior sensitivity over cTn is no longer valid.
- Heart-type fatty acid binding protein, copeptin, and plasma free fatty acids may offer a small incremental gain in diagnostic value, particularly the negative predictive value, when used with hs-cTn on admission.
Conclusions:
- High-sensitive cardiac troponin (hs-cTn) assays are the preferred single marker for acute myocardial infarction diagnosis.
- The added diagnostic benefit of alternative biomarkers like heart-type fatty acid binding protein, copeptin, and plasma free fatty acids in conjunction with hs-cTn is minimal.
- Further research is required to ascertain if these additional markers improve diagnosis or offer advantages over established hs-cTn protocols involving serial measurements.
Abstract:
In the case of suspected acute coronary syndrome and myocardial infarction positive diagnosis or exclusion strongly depend on the use of biomarkers and in particular cardiac troponins (cTn). Especially in the early phase of myocardial infarction the sensitivity of cTn assays has been unsatisfactory. This has led to the investigation of many other potential markers for the early diagnosis of myocardial infarction. In addition, several traditional markers have been advocated, e.g., myoglobin, as these were considered to be more sensitive than cTn. With the advent of high-sensitive (hs) cTn assays the value and practical use of the alternative or additional markers has to be reassessed. According to the currently available data, no single marker is superior to hs-cTn for the diagnosis of acute myocardial infarction. In particular, the notion of superior sensitivity of myoglobin compared to cTn no longer holds true. There are two protein markers, heart-type fatty acid binding protein and copeptin, and plasma free fatty acids that may increase the diagnostic value and specifically the negative predictive value when determined on admission in combination with hs-cTn. However, the incremental gain, if any, is small. Further data are needed to determine, whether these markers can in fact improve diagnosis and if they are superior to the recommended use of the relative or absolute change of hs-cTn after 3 h.
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