Ischaemic and Inflammatory Biomarkers in Cardiovascular Disease
Despite major advances in diagnosis and management, coronary artery disease continues to be a major public health problem. Patients with chest pain represent a heterogeneous group with varying presentation or severity of coronary artery disease and cardia
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Ischaemic and Inflammatory Biomarkers in Cardiovascular Disease
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Gopinath Gnanasegaran, Gregory Shabo and John R. Buscombe
7.1
Contents
7.1 7.2 7.2.1 7.2.2 7.2.3 7.2.4 7.2.5 7. 3
7. 4 7. 5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . Current Markers of Myocardial Injury . . . . Creatine Kinase (CK) and CK-MB . . . . . . . . Cardiac Troponins . . . . . . . . . . . . . . . . . . . . . . Lactate Dehydrogenase (LDH) . . . . . . . . . . . Myoglobins . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-reactive Protein (CRP) . . . . . . . . . . . . . . . . Clinical Settings and Selection of a Diagnostic Marker . . . . . . . . . . . . . . . . . . Recent Advances and Future Ischaemic and Inflammatory Markers . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction
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Despite major advances in diagnosis and management, coronary artery disease continues to be a major public health problem. Patients with chest pain represent a heterogeneous group with varying presentation or severity of coronary artery disease and cardiac risk. Early prognostic evaluation of future cardiovascular risk is necessary for the application of appropriate treatment and optimal management in patients with chest pain. The role of cardiac markers in the diagnosis and management of patients with chest pain or in patients with suspected acute coronary syndromes (ACS) have improved dramatically with major technological advances. Currently various serum markers such as creatine kinase (CK)-MB, lactate dehydrogenase (LDH), myoglobin and cardiac troponins T (cTnT) and I (cTnI) are readily available and used as plasma diagnostic markers of myocardial necrosis in acute myocardial infarction (AMI) [1–18] (Table 7.1). Patients with AMI generally present with chest pain with or without radiation to the jaw or arm. In general, patients will have associated electrocardiogram (ECG) changes. In patients presenting with classical symptoms and ECG changes, the role of cardiac markers is generally limited, however, some patients may present atypically. In these circumstances the cardiac markers may assist in the diagnosis of AMI. The cardiac specific diagnostic markers appear and disappear at various stages of myocardial damage. The time of onset of the symptom is reported to play an important role in the assessment of the importance of these markers. The best marker depends on the time of onset of chest pain or other symptoms. An ideal marker should appear early in the blood and persists for a long time to be measured or detected (Table 7.2) [18]. In the early 1980s creatine kinase (CK)-MB activity and lactate dehydrogenase (LDH) were used as the best markers of myocardial necrosis, and in the 1990s CK-
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Gopinath Gnanasegaran, Gregory Shabo and John R. Buscombe
Table 7.1 Markers of myocardial injury [1, 9–12, 14–17]
Markers of myocardial inj
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