[Markers of coronary damage. From diagnosis to prognosis]

Abstract

Cardiovascular disease is a major public health problem. Rapid and accurate diagnosis in the emergency department is essential for timely initiation of treatment, thus any means for improving the speed and accuracy of acute coronary syndrome (ACS) diagnosis can contribute to better clinical and economic outcomes. Measurement of circulating level of troponin has proven to be a sensitive and specific test for cardiac damage detection but they do not discriminate between ischemic and not ischemic etiologies of myocardial injury. Combining troponin with other cardiac biomarkers may offer complimentary information on the underlying pathobiology and prognosis in an individual patient, may increase the analytic sensitivity for myocardial damage and offer insights into the timing and mechanism of myocardial injury. Several prospective epidemiological studies have documented an association between inflammatory markers and cardiovascular disease and their role in primary and secondary prevention and as predictor of mortality.

Objective: We sought to report a selected but representative evidence on some new biological markers of cardiac damage, including inflammatory cytokines in patients with cardiovascular disease.

Data sources: We searched in Medline from January 1998 to March 2005 for all studies focusing on the diagnostic and prognostic value of new markers of cardiac damage in patients with ACS and heart failure.

Conclusion: The use of necrotic markers to risk stratify patients with chest pain has become an established practice in the clinical setting while the role of other inflammatory biomarkers, despite being still undefined, seems promising under both pathophysiologic and prognostic perspective.