Diagnostic strategies in myocardial infarction using myoglobin measurement

Determination of myoglobin, a low molecular weight haeme protein (17.8 kDa), present in both cardiac and skeletal muscle, is an old test with new perspectives. Advantages and disadvantages of myoglobin determination are well known; recent availability of rapid and accurate methods for the assay of this protein has greatly enhanced interest in the clinical utilization of the test. However, since myoglobin is present in both skeletal and cardiac muscle, any damage to these muscle types results in its release in blood and, consequently, high levels of the protein are observed in conditions unrelated to acute myocardial infarction (AMI). New strategies for myoglobin measurement may resolve this limitation. These strategies include both the combined measurement of myoglobin and a skeletal specific marker (carbonic anhydrase III) or a cardiac specific marker (troponin I or T), as well as myoglobin evaluation on serial samples. In particular. the diagnostic algorithm based on combined measurement of myoglobin and troponins significantly improves diagnostic efficiency in laboratory assessment of suspected AMI patients. However, further efforts are necessary to improve the standardization of present methods for myoglobin measurement: the significant disagreement demonstrated between some commercially available assays should be carefully considered in clinical practice.