Troponins and other biomarkers in the early diagnosis of acute myocardial infarction

Abstract

Chest pain is a common presenting symptom; however, the majority of emergency chest pain admissions are not due to acute myocardial infarction (AMI). AMI can be life threatening and early diagnosis or rule out of AMI might potentially improve morbidity and mortality, as well as reduce time to decision and therefore overall treatment costs. High-sensitivity troponin (hs-troponin) assays have been developed that enable precise quantification of extremely low troponin concentrations. Such hs-troponin assays are recommended in early rule-out protocols for AMI, when measured at presentation and again at 3-6 h. However, troponin is less than ideally suited for early diagnosis of acute myocardial injury because of its slow rise, late peak and low specificity for coronary plaque rupture. A new biomarker with a more rapid elevation to peak concentration than hs-troponin and lower background levels in patients with chronic cardiovascular conditions would be a preferred diagnostic test. This review discusses the development of hs-troponin assays and other biomarkers, evaluates their place in the early diagnosis of AMI, discusses troponin elevation without AMI and discusses current guideline recommendations.

Combination of Platelet expression of PKCepsilon and cardiac troponin-I for early diagnosis of chest pain patients in the emergency department

“…As compared to other several AMI biomarkers that have been recently described 25,26 , our study is characterized by two main novelties. First, the target of our assay, i.e.…”

“…Currently, high sensitivity troponin assay has improved speed and accuracy of clinical decision for CP patients at ED. Nevertheless, troponin is influenced by a multitude of clinical factors 26,28 . Consequently, the enhanced sensitivity is inevitably accompanied by a reduction in specificity 12 , which in turns leads to increasing cardiology consultations for a safe rule-out.…”

miR-187 modulates cardiomyocyte apoptosis and oxidative stress in myocardial infarction mice via negatively regulating DYRK2

“…The mechanism of myocardial infarction remodeling leading to heart failure is complex, mostly related to the disordering of an assailable atherosclerotic plaque [2]. In addition, the early diagnosis of myocardial infarction depends on biomarker corroboration of myocyte apoptosis [3] and either electrocardiographic (ECG) criteria of ischemia or infarction [4]. The ECG signal is a useful technique, which can be used to identify cardiac irregularity.…”

Immunobinding‐induced alteration in the electrophoretic mobility of proteins: An approach to studying the preconcentration of an acidic protein under cationic isotachophoresis

“…Despite their potential social impact and clinical significance, the application of PADs in POC diagnosis of malignant diseases at their early stages is hindered by the poor sensitivity and detection limit of the technology. It is known that typical PADs based on lateral flow immunoassay have relatively poor detection limits (∼10 ‐11 mol/L) , while the serum concentrations of many biomarkers of malignant diseases, such as cardiovascular diseases and cancers, are much lower (10 ‐12 to 10 ‐16 mol/L) at their early stages . When PADs are used in serum sample tests, the sensitivity and detection limits of the technology are further hindered by the millimolar concentrations of abundant serum proteins, such as albumin and globulin, which can significantly interfere with immunobinding of the relevant biomarkers, which may be present in nano‐/pico‐molar concentrations.…”