Study Update : The ongoing evolution of cardiac bio markers for myocardial infarction - - -Cardiac biomarkers are crucial Today the preferred biomarkers used to identify suspected MI are cardiac troponins, which are regulatory proteins found in the heart muscle that can detect injury to the heart.2 Cardiac troponin I (cTnI) was first described as a biomarker specific for MI in 1987,3 and troponin T (cTnT) was first described in 1989.4 It was many years before cardiac troponin (cTn) was incorporated into guidelines and recommendations as a preferred marker for use in the diagnosis of MI.5 This transition from the historical markers of cardiac injury, myoglobin (MB), creatine kinase (CK), and lactate dehydrogenase (LD), required many studies that would show the benefits of cTn over the standard of care of the time. This led to the initial improvements in the time to diagnosis which cTn brought. Thus the expectations are high for studies and research that would be required to show improvements over the current standard of care that utilizes cTn. - - - -New criteria for diagnoses In addition to cardiac troponins being used in the diagnosis of MI, these diagnostics are helping clinicians redefine some of these diagnoses and their criteria. For many years, the diagnosis of acute MI relied on the revised criteria established by the World Health Organization (WHO) task force in 1979.6 These criteria were epidemiological and aimed at specificity. A joint European Society of Cardiology (ESC) and American College of Cardiology (ACC) committee proposed a more clinically based definition of an acute, evolving, or recent MI in 2000.7 In 2007 the Joint Task Force of the European Society of Cardiology, American College of Cardiology Foundation, the American Heart Association, and the World Health Federation (ESC/ACCF/AHA/WHF) refined the 2000 criteria and defined acute MI as a clinical event consequent to the death of cardiac myocytes (myocardial necrosis) that is caused by ischemia (as opposed to other etiologies such as myocarditis or trauma).5 This definition was not fundamentally changed in the third universal definition of MI released in 2012 by the ESC/ACCF/AHA/WHF2 and includes the following criteria for the diagnosis of MI: detection of a rise and/or fall of cardiac biomarker values (preferably cTn with at least one value above the 99th percentile upper reference limit [URL]) and with at least one of the following: - - - - - - Symptoms of ischemia Development of pathologic Q waves in the ECG New or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB) Identification of an intracoronary thrombus by angiography or autopsy Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality. . . details are here : mlo-online/articles/201308/the-ongoing-evolution-of-cardiac-biomarkers-for-myocardial-infarction.php
Posted on: Tue, 06 Aug 2013 04:41:24 +0000
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