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Abstract
The use of biochemical markers in the diagnosis and management of patients with acute coronary syndrome has increased continually in recent decades. The development of highly sensitive and cardiac-specific troponin assays has changed the view on diagnosis of myocardial infarction and also extended the role of biochemical markers of necrosis into risk stratification and guidance for treatment. The consensus definition of myocardial infarction places increased emphasis on cardiac marker testing, with cardiac troponin replacing creatine kinase MB as the “gold standard” for diagnosis of myocardial infarction. Along with advances in the use of more cardiac-specific markers of myocardial necrosis, biochemical markers that are involved in the progression of atherosclerotic plaques to the vulnerable state or that signal the presence of vulnerable plaques have recently been identified. These markers have variable abilities to predict the risk of an individual for acute coronary syndrome. The aim of this review is to provide an overview of the well-established markers of myocardial necrosis, with a special focus on cardiac troponin I, together with a summary of some of the potential future markers of inflammation, plaque instability, and ischemia.
Key words :
- Cardiac troponin I
- cardiac troponin T
- CD40 ligand
- choline
- C-reactive protein
- creatine kinase MB
- fatty acid-binding protein
- interleukin-6
- ischemia
- ischemia-modified albumin
- myocardial infarction
- myocardial injury
- myocardial necrosis
- myoglobin
- myeloperoxidase
- placental growth factor
- plaque instability
- pregnancy-associated plasma protein A
- soluble adhesion molecules
- tumor necrosis factor-α
- unbound free fatty acids
- unstable angina
| Abbreviations | ||
| aa | = | amino acid |
| AACC | = | American Association for Clinical Chemistry |
| ACB | = | albumin cobalt binding |
| ACS | = | acute coronary syndrome |
| ADIFAB | = | acrylodated intestinal fatty acid-binding protein |
| AMI | = | acute myocardial infarction |
| CD40L | = | CD40 ligand |
| CD40 | = | CD40 receptor |
| CHD | = | coronary heart disease |
| CK | = | creatine kinase |
| CK-MB | = | MB isoenzyme of creatine kinase |
| CRP | = | C-reactive protein |
| C-SMCD | = | IFCC Committee on Standardization of Markers of Cardiac Damage |
| cTnI | = | cardiac troponin I |
| cTnT | = | cardiac troponin T |
| CV | = | coefficient of variation |
| CVD | = | cardiovascular disease |
| ECG | = | electrocardiogram |
| ESC/ACC | = | European Society of Cardiology/Americal College of Cardiology |
| FABPs | = | fatty acid-binding proteins |
| FFA | = | free fatty acid |
| FFAu | = | unbound free fatty acids |
| fTnI | = | fast skeletal troponin I |
| GP | = | glycoprotein |
| H-FABP | = | heart-type fatty acid-binding protein |
| ICAM-1 | = | intracellular adhesion molecule-1 |
| IgG | = | immunoglobulin G |
| IgM | = | immunoglobulin M |
| IGF | = | insulin-like growth factors |
| IGFBP | = | insulin-like growth factor binding proteins |
| IL | = | interleukin |
| IMA | = | ischemia-modified albumin |
| kDa | = | kilodalton |
| LD | = | lactate dehydrogenase |
| LDL | = | low-density lipoprotein |
| MI | = | myocardial infarction |
| MPO | = | myeloperoxidase |
| NIST | = | National Institute of Standards and Technology |
| NSTEMI | = | non-ST-elevation myocardial infarction |
| oxLDL | = | oxidized low-density lipoprotein |
| PAPP-A | = | pregnancy-associated plasma protein A |
| PCTA | = | percutaneous transluminal coronary angioplasty |
| PKA | = | protein kinase A |
| PKC | = | protein kinase C |
| PlGF | = | placental growth factor |
| POC | = | point-of-care |
| proMBP | = | proform of eosinophil major basic protein |
| sCD40L | = | soluble CD40 ligand |
| sICAM-1 | = | soluble intracellular adhesion molecule-1 |
| ST | = | ST segment of ECG tracing |
| STEMI | = | ST-elevation myocardial infarction |
| sTnI | = | slow skeletal troponin I |
| sVCAM-1 | = | soluble vascular cell adhesion molecule-1 |
| TnC | = | troponin C |
| TNF-α | = | tumor necrosis factor-α |
| TnI | = | troponin I |
| TnT | = | troponin T |
| VCAM-1 | = | vascular cell adhesion molecule-1 |
| WBCHO | = | whole blood choline |
| UA | = | unstable angina |
| Abbreviations | ||
| aa | = | amino acid |
| AACC | = | American Association for Clinical Chemistry |
| ACB | = | albumin cobalt binding |
| ACS | = | acute coronary syndrome |
| ADIFAB | = | acrylodated intestinal fatty acid-binding protein |
| AMI | = | acute myocardial infarction |
| CD40L | = | CD40 ligand |
| CD40 | = | CD40 receptor |
| CHD | = | coronary heart disease |
| CK | = | creatine kinase |
| CK-MB | = | MB isoenzyme of creatine kinase |
| CRP | = | C-reactive protein |
| C-SMCD | = | IFCC Committee on Standardization of Markers of Cardiac Damage |
| cTnI | = | cardiac troponin I |
| cTnT | = | cardiac troponin T |
| CV | = | coefficient of variation |
| CVD | = | cardiovascular disease |
| ECG | = | electrocardiogram |
| ESC/ACC | = | European Society of Cardiology/Americal College of Cardiology |
| FABPs | = | fatty acid-binding proteins |
| FFA | = | free fatty acid |
| FFAu | = | unbound free fatty acids |
| fTnI | = | fast skeletal troponin I |
| GP | = | glycoprotein |
| H-FABP | = | heart-type fatty acid-binding protein |
| ICAM-1 | = | intracellular adhesion molecule-1 |
| IgG | = | immunoglobulin G |
| IgM | = | immunoglobulin M |
| IGF | = | insulin-like growth factors |
| IGFBP | = | insulin-like growth factor binding proteins |
| IL | = | interleukin |
| IMA | = | ischemia-modified albumin |
| kDa | = | kilodalton |
| LD | = | lactate dehydrogenase |
| LDL | = | low-density lipoprotein |
| MI | = | myocardial infarction |
| MPO | = | myeloperoxidase |
| NIST | = | National Institute of Standards and Technology |
| NSTEMI | = | non-ST-elevation myocardial infarction |
| oxLDL | = | oxidized low-density lipoprotein |
| PAPP-A | = | pregnancy-associated plasma protein A |
| PCTA | = | percutaneous transluminal coronary angioplasty |
| PKA | = | protein kinase A |
| PKC | = | protein kinase C |
| PlGF | = | placental growth factor |
| POC | = | point-of-care |
| proMBP | = | proform of eosinophil major basic protein |
| sCD40L | = | soluble CD40 ligand |
| sICAM-1 | = | soluble intracellular adhesion molecule-1 |
| ST | = | ST segment of ECG tracing |
| STEMI | = | ST-elevation myocardial infarction |
| sTnI | = | slow skeletal troponin I |
| sVCAM-1 | = | soluble vascular cell adhesion molecule-1 |
| TnC | = | troponin C |
| TNF-α | = | tumor necrosis factor-α |
| TnI | = | troponin I |
| TnT | = | troponin T |
| VCAM-1 | = | vascular cell adhesion molecule-1 |
| WBCHO | = | whole blood choline |
| UA | = | unstable angina |