Past, Present, and Future of Blood Biomarkers for the Diagnosis of Acute Myocardial Infarction—Promises and Challenges

Abstract

Despite important advancements in acute myocardial infarction (AMI) management, it continues to represent a leading cause of mortality worldwide. Fast and reliable AMI diagnosis can significantly reduce mortality in this high-risk population. Diagnosis of AMI has relied on biomarker evaluation for more than 50 years. The upturn of high-sensitivity cardiac troponin testing provided extremely sensitive means to detect cardiac myocyte necrosis, but this increased sensitivity came at the cost of a decrease in diagnostic specificity. In addition, although cardiac troponins increase relatively early after the onset of AMI, they still leave a time gap between the onset of myocardial ischemia and our ability to detect it, thus precluding very early management of AMI. Newer biomarkers detected in processes such as inflammation, neurohormonal activation, or myocardial stress occur much earlier than myocyte necrosis and the diagnostic rise of cardiac troponins, allowing us to expand biomarker research in these areas. Increased understanding of the complex AMI pathophysiology has spurred the search of new biomarkers that could overcome these shortcomings, whereas multi-omic and multi-biomarker approaches promise to be game changers in AMI biomarker assessment. In this review, we discuss the evolution, current application, and emerging blood biomarkers for the diagnosis of AMI; we address their advantages and promises to improve patient care, as well as their challenges, limitations, and technical and diagnostic pitfalls. Questions that remain to be answered and hotspots for future research are also emphasized.

Three cardiac biomarkers and their efficacy: A review

“…MicroRNAs appear to be particularly promising in this regard, given that myocyte stress induced by anoxia, acidosis, and/or edema precedes myocardial necrosis in AMI patients and is rapidly reflected in circulating miRNAs levels. The rapid progress in molecular biomarker research must be matched, however, by similar progresses in laboratory techniques as well [1][2][3][4] . Troponin on the other hand, show superior diagnostic efficacy.…”

“…When the test shows normal troponin T values measured over specific time intervals, it rules out the possibility of any heart damage. Troponin T not only serves a diagnostic tool, but also can be useful for prognosis 3 . It is non enzymatic biomarker.…”

“…Troponin elevation in these patients has been shown to be a prognostic factor, though the mechanism of this relationship is unclear. Its levels are also increased in drug toxicity, Hypertension, Hypotension, renal failure, sepsis, and hypothyroidism [3][4] About 20% of total Creatin Kinase in the myocardium is in the MB form, giving sensitivity and specificity in the diagnosis of acute myocardial infarction. CK-MB has a ratio of 5% in skeletal muscle.…”

“…Therefore, these conditions should be considered when using CK-MB as a biomarker in the diagnosis of AMI. [3][4] .…”

Comparative Assessment of Different Gold Nanoflowers as Labels for Lateral Flow Immunosensors

“…Taking into consideration several immunoreagents' combinations with different affinities and specificities makes it possible to assess the general nature of the patterns observed when comparing nanoparticles. The selected compounds belong to biomarkers released into the blood after an acute myocardial infarction and controlled during diagnosis [26,27]. Solutions for lowering their LODs, especially for troponins, help increase the reliability of emergency medical diagnostics and minimize false-negative test results [28,29].…”