Biomarkers in Acute Cardiac Disease
The Present and the Future
Allan S. Jaffe, MD*,*,
Luciano Babuin, MD* and
Fred S. Apple, PhD
* Division of Cardiovascular Diseases, Department of Medicine and the Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, Minnesota
Hennepin County Medicine Center and the University of Minnesota School of Medicine, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota
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Figure 1 The percentage of values for cardiac troponin (cTn)T collected from the FRISC II study associated with elevated values for a point-of-care assay with less sensitivity and precision. Any cTnT value >0.01 ng/ml is abnormal. Note that even at a value 20 times the upper limit of normal (0.2 ng/ml) for cTnT, only 60% of the values with the less sensitive assay were detected. Thus, rather than troponin identifying 139 of the 154 patients who eventually died, the point-of-care assay identified only 98 patients. Reprinted, with permission, from James et al. (6). R-TnI = rapid troponin I.
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Figure 2 Sensitivity and precision of various cardiac troponin I (cTnI) assays as provided by measurements made by the manufacturers from pools provided by the International Federation for Clinical Chemistry committee. (A to G) Increasing concentrations of cTnI. Note that many assays are incapable of detecting the lower values with reasonable precision. Reprinted, with permission, from Panteghini et al. (13). CV = coefficient of variation.
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Figure 3 Time course of the appearance of various markers in the blood after acute myocardial infarction (AMI). Shown are the time concentrations/activity curves for myoglobin and creatine kinase (CK) isoforms, troponin after large and small infarctions, and CK-MB. Note that with cardiac troponin some patients have a second peak in addition. CV = coefficient of variation.
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Figure 4 Sensitivity of cardiac troponin (cTn)I compared with myoglobin and creatine kinase (CK)-MB for the detection of myocardial injury. Note the use of the 10% coefficient of variation (0.1 ng/ml) were superior to the use of myoglobin. Reprinted, with permission, from Eggers et al. (19).
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Figure 5 Cardiac events after emergency department discharge based on levels of cardiac troponin T. Reprinted, with permission, from Henrikson et al. (42).
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Figure 6 Synergistic prognostic value of C-reactive protein (CRP) and low-density lipoprotein (LDL) in PROVE-IT study. Reprinted, with permission, from Ridker et al. (68). MI = myocardial infarction.
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Figure 7 Effect of weight on B-type natriuretic peptide (BNP) levels. Reprinted, with permission, from Krauser et al. (77). BMI = body mass index.
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