Cardiac Troponins I and T: Molecular Markers for Early Diagnosis, Prognosis, and Accurate Triaging of Patients with Acut
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Cardiac Troponins I and T: Molecular Markers for Early Diagnosis, Prognosis, and Accurate Triaging of Patients with Acute Myocardial Infarction Ram P. Tiwari • Anubhav Jain • Zakir Khan • Veena Kohli • R. N. Bharmal • S. Kartikeyan • Prakash S. Bisen
Published online: 27 November 2012 Springer International Publishing Switzerland 2012
Abstract Acute myocardial infarction (AMI) is the leading cause of death worldwide, with early diagnosis still being difficult. Promising new cardiac biomarkers such as troponins and creatine kinase (CK) isoforms are being studied and integrated into clinical practice for early diagnosis of AMI. The cardiac-specific troponins I and T (cTnI and cTnT) have good sensitivity and specificity as indicators of myocardial necrosis and are superior to CK and its MB isoenzyme (CK-MB) in this regard. Besides being potential biologic markers, cardiac troponins also provide significant prognostic information. The introduction of novel high-sensitivity troponin assays has enabled more sensitive and timely diagnosis or exclusion of acute coronary syndromes. This review summarizes the available information on the potential of troponins and other cardiac markers in early diagnosis and prognosis of AMI, and
A. Jain and Z. Khan contributed equally to this work. R. P. Tiwari A. Jain V. Kohli Diagnostic Division, RFCL Limited (formerly Ranbaxy Fine Chemicals Limited), Avantor Performance Materials, New Delhi, India Z. Khan Viral Neuro-Immunology Unit, Department of Virology, Institut Pasteur, Paris, France R. N. Bharmal S. Kartikeyan Preventive and Social Medicine, Department of Microbiology, Rajiv Gandhi Medical College, Kalwa, Thane, India P. S. Bisen (&) Defence Research and Development Establishment (DRDE), Defence Research and Development Organization (DRDO), Ministry of Defence, Government of India, Jhansi Road, Gwalior 474002, India e-mail: [email protected]
provides perspectives on future diagnostic approaches to AMI.
1 Introduction Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with a higher death rate annually than that of any other disease [1, 2]. Millions of people suffer from one or more forms of cardiovascular disease, such as hypertension, coronary artery disease, or stroke. According to a World Health Organization report in 2011 [2], an estimated 17.3 million people died from cardiovascular disease in 2008, representing 30 % of all global deaths. Currently, a higher death rate is reported in high-income countries such as the USA, but the percentage is increasing rapidly in low-income countries as well. It is speculated that by 2030, around 23.6 million people will die from cardiovascular diseases, mainly from heart disease and stroke. The largest increase in the number of deaths will occur in the South-East Asia region [2]. Acute myocardial infarction (AMI) most commonly starts with a coronary artery blockage as a result of thrombosis at the site of rupture of a vulnerable atherosclerotic plaque. If the resulting ischemia exc
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