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ARTICLE

Ingenuous interpretation of elevated blood levels of macromolecular markers of myocardial injury: a recipe for confusion

^a Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA

Manuscript received July 30, 1999; revised manuscript received October 27, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. Burton E. Sobel, Department of Medicine, University of Vermont, Colchester Research Facility, 55A S. Park Drive, Colchester, Vermont 05446
burton.sobel{at}vtmednet.org

Several assumptions about elevations of macromolecular markers of myocardial injury in blood require critical consideration. The dichotomy of modest, persistent elevations of troponins I and T as prognostic factors in patients with unstable angina and absent elevations of isoenzymes of creatine kinase is presently unexplained. Factors influencing the appearance of macromolecular markers of myocardial injury in blood are considered, including the need to estimate baseline values, to consider elevations as deviations from baseline rather than simply points within a distribution of baseline values in normal subjects, to recognize operative biochemical and physiologic determinants of marker release from injured myocytes and washout and to take into account the influence of apoptosis. Elucidation and consideration of mechanisms underlying the appearance of specific macromolecular markers in blood appear likely to improve diagnosis and explain the prognostic power of the troponins in patients with unstable angina. Detection of proteolytic breakdown products of troponins in blood is likely to explain the modest, persistent elevations seen in some patients with unstable angina and their prognostic implications.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK = creatine kinase   HBD = hydroxybutyric acid dehydrogenase   LDH = lactate dehydrogenase   MB = myocardial band   MI = myocardial infarction   TnC = troponin C   TnI = troponin I   TnT = troponin T

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