Cardiac biomarkers: definition, detection, diagnostic use, and efficiency
The Detection of Biomarkers: Past, Present, and the Future Prospects, Elsevier, ss.113-130, 2022
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2022
- Doi Numarası: 10.1016/b978-0-12-822859-3.00007-9
- Yayınevi: Elsevier
- Sayfa Sayıları: ss.113-130
- Anahtar Kelimeler: acute coronary syndrome, cardiac biomarkers, Cardiovascular disease, coronary artery disease, coronary heart disease, myocardial infarction
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Cardiovascular disease (CVD) is a very common diagnosis in both men and women and accounts for 30% of deaths worldwide. As CVD is a group of diseases that include both the heart and blood vessels, coronary heart disease (CHD), coronary artery disease (CAD), and acute coronary syndrome (ACS) among several other conditions are classified all as CVD. ACS is basically defined as the decrease in the oxygen amount reaching the myocardial tissue known as “ischemia.” Myocardial infarction (MI) is an example of this as cell death causes damaged or destroyed cardiac tissue. Even if there is no cell death, the diminished blood flow changes the cardiac dynamics, which increases the risk of MI. Early detection of coronary ischemia is of critical importance. Cardiac biomarkers are endogenous substances released into circulation following heart tissue damage and they play important roles in diagnosis, management, and risk stratification of patients with ACS. Clinical use of cardiac biomarkers has started back in 1960s, with the enzyme aspartate aminotransferase, followed by lactate dehydrogenase and myoglobin. In 1980s, a cardiac-specific iso-enzyme CK-MB was the biomarker of choice in diagnosis of ACS for a decade with the main drawback of high false-positive results. In 1990s, the discovery of cardiac troponins has opened a new era in ACS diagnosis as these were cardiac-specific molecules and the sensitivity for detecting troponin T and I approaches 100% when sampled 6-12h after acute chest pain onset. Today, high-sensitivity troponins are accepted as the gold standard cardiac markers with their high cardiac specificity and high assay sensitivity. Extensive research for development and validation of new cardiac biomarkers like myeloperoxidase and heart-type fatty acid-binding protein is being carried out and the number of novel biomarkers is expected to increase in the following years; and the ultimate goal will be the determination of markers to add more value to highly improved ACS management. Coronary heart disease develops when the major blood vessels that supply the heart become damaged. Coronary heart disease is not an acute event, in time the reduced blood flow may cause chest pain (angina), shortness of breath, or some variety of different CAD symptoms. A heart attack occurs when there is a complete blockage of blood flow. As it is not an acute cardiac event, prognostic biomarkers in risk stratification and follow-up of patients’ candidate for CHD development are more important. Generally, physical examination and developing symptoms are more prominent in CHD diagnosis and prognosis. But to support clinical findings, two most promising biomarkers widely used are high-sensitive C-reactive protein and homocysteine.