Skip to main content
Log in

Clinical and pathobiologic considerations in the evaluation of markers of myocardial ischemia

  • Published:
Cardiovascular Toxicology Aims and scope Submit manuscript

Abstract

There is a need for blood-based analytic techniques that allow for the detection of patients either with reversible myocardial ischemia or who are at risk for myocardial ischemia. However, given the diverse etiologies of unstable angina and the complex interactions among various cell types, the term “marker for ischemia” should be used with caution (if at all). Unless we find a protein that is released across the diverse pathologic triggers associated with the various stages of progression of atherosclerosis and cellular ischemia, we will be forced to consider a spectrum of proteins (and analytic assays) that are situationally specific. The choice of an appropriate gold standard as we investigate the clinical application of these assays will be one of the most difficult and most important decisions in these studies. It will be critical that conclusions of usefulness in one setting of ischemic heart disease not be generalized in the absence of clinical trials supporting that contention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Falahati, A., Sharkey, S.W., Christensen, D., McCoy, M., Miller, E.A., Murakami, M.A., et al. (1999). Implementation of serum cardiac troponin I as marker for detection of acute myocardial infarction. Am. Heart J. 137(2):332–337.

    Article  PubMed  CAS  Google Scholar 

  2. Adams, J.E. and Miracle, V.A. (2001). Acute coronary syndromes: pathophysiology, clinical presentation, and initial diagnostic strategies, in Markers in Cardiology: Current and Future Clinical Applications (J.E. Adams, F.S. Apple, A.S. Jaffe, and A.H.B. Wu, eds), pp. 47–63, Futura Publishing, Armonk, NY.

    Google Scholar 

  3. Cannon, C.P., McCabe, C.H., Stone, P.H., Rogers, W.J., Schactman, M., Thompson, B.W., et al. (1997). The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q-wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J. Am. Coll. Cardiol. 30:133–140.

    Article  PubMed  CAS  Google Scholar 

  4. Stubbs, P., Collinson, P., Moseley, D., Greenwood, T., and Noble, M. (1996). Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 94(6):1291–1297.

    PubMed  CAS  Google Scholar 

  5. Antman, E.M., Tanasijevic, M.J., Thompson, B., Schactman, M., McCabe, C.H., Cannon, C.P., et al. (1996). Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N. Engl. J. Med. 335(18):1342–1349.

    Article  PubMed  CAS  Google Scholar 

  6. Wu, A.H. and Lane, P.L.. (1995). Meta-analysis in clinical chemistry: validation of cardiac troponin T as a marker for ischemic heart diseases Clin. Chem. 41(8 Pt. 2):1228–1233.

    PubMed  CAS  Google Scholar 

  7. Newby, L.K., Kaplan, A.L., Granger, B.B., Sedor, F., Califf, R.M., and Ohman, E.M. (2000). Comparison of cardiac troponin T versus creatine kinase-MB for risk stratification in a chest pain evaluation unit. Am. J. Cardiol. 85(7): 801–805.

    Article  PubMed  CAS  Google Scholar 

  8. Joint European Society of Cardiology/American College of Cardiology (2000). Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J. Am. Coll. Cardiol. 36:959–969.

    Article  Google Scholar 

  9. Wu, A.H.B. and Ford, L. (1999). Release of biochemical markers in acute coronary syndromes: ischemia or only necrosis? Clin. Chim. Acta 284:161–171.

    Article  PubMed  CAS  Google Scholar 

  10. Antman, E.M., Grudzien, C., Mitchell R.N., and Sacks, D.B. (1997). Detection of unsuspected myocardial necrosis by rapid bedside assay for cardiac troponin T. Am. Heart J. 133:596–598.

    Article  PubMed  CAS  Google Scholar 

  11. Chen, Y.J., Serfass, R.C., Mackey-Bojack, S., Kelly, K.L., Titus, J.L., and Apple, F.S. (2000). Cardiac troponin T alterations in myocardium and serum of rats following stressful, prolonged intense exercise. J. Appl. Physiol. 88: 1749–1755.

    PubMed  CAS  Google Scholar 

  12. Ohman, E.M., Armstrong, P.W., White, H.D., Granger, C.B., Wilcox, R.G., Weaver, W.D. et al. (1999). Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction. GUSTOIII Investigators. Global use of strategies to open occluded coronary arteries. Am. J. Cardiol. 84(11):1281–1286.

    Article  PubMed  CAS  Google Scholar 

  13. Hamm, C.W., Goldmann, B.U., Heeschen, C., Kreymann, G., Berger, J., and Meinertz, T. (1997). Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N. Engl. J. Med. 337(23):1648–1653.

    Article  PubMed  CAS  Google Scholar 

  14. Braunwald, E. (1998). Unstable angina: An etiologic approach to management. Circulation 98:2219–2222.

    PubMed  CAS  Google Scholar 

  15. Dalager-Pedersen, S., Pedersen, E.M., Ringgaard, S., and Falk, E. (1998). Coronary artery disease: plaque vulnerability, disruption, and thrombosis, in The Vulnerable Atherosclerotic Plaque: Understanding, Identification and Modification (V. Fuster, ed), pp. 1–23. Futura Publishing, Armonk, NY.

    Google Scholar 

  16. Hamm, C.W. and Braunwald, E. (2000). A classification of unstable angina revisited. Circulation 102:118–122.

    PubMed  CAS  Google Scholar 

  17. Jennings, R.B. and Reimer, K.A. (1991). The cell biology of acute myocardial ischemia. Annu. Rev. Med. 42:225–246.

    Article  PubMed  CAS  Google Scholar 

  18. Gibson, R.S. and Beller, G.A. (1982). Should exercise electrocardiographic testing be replaced by radioisotope methods? in Controversies in Coronary Artery Disease (S.H. Rahimtoola and A.D. Brest, eds), pp. 1–31, F.A. Davis, Philadelphia.

    Google Scholar 

  19. Mizunoi, K., Satomura, K., Miyamoto, A., Arakawa, K., Shibuya, T., Arai, T., et al. (1992). Angioscopic evaluation of coronary-artery thrombi in acute coronary syndrome. N. Engl. J. Med. 326:287–291.

    Article  Google Scholar 

  20. Mercho, N., Waters, D., Craven, T., et al. (1995). Quantitative coronary arteriographic comparison of the culprit lesions of unstable angina and myocardial infarction in a prospectively defined population. Circulation 92(Suppl I):I-719.

    Google Scholar 

  21. Little, W.C., Constantinescu, M., Applegate, R.J., et al. (1998). Can arteriography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 78:1157–1166.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jesse E. Adams M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adams, J.E. Clinical and pathobiologic considerations in the evaluation of markers of myocardial ischemia. Cardiovasc Toxicol 1, 135–139 (2001). https://doi.org/10.1385/CT:1:2:135

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/CT:1:2:135

Key Words

Navigation