Cardiovascular Toxicology

, Volume 1, Issue 2, pp 135–139 | Cite as

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



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.

Key Words

Ischemia biomarkers myocardial infarction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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.PubMedCrossRefGoogle Scholar
  2. 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. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Braunwald, E. (1998). Unstable angina: An etiologic approach to management. Circulation 98:2219–2222.PubMedGoogle Scholar
  15. 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. 16.
    Hamm, C.W. and Braunwald, E. (2000). A classification of unstable angina revisited. Circulation 102:118–122.PubMedGoogle Scholar
  17. 17.
    Jennings, R.B. and Reimer, K.A. (1991). The cell biology of acute myocardial ischemia. Annu. Rev. Med. 42:225–246.PubMedCrossRefGoogle Scholar
  18. 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. 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.CrossRefGoogle Scholar
  20. 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. 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

Copyright information

© Humana Press Inc. All rights of any nature whatsoever reserved 2001

Authors and Affiliations

  1. 1.Jewish Hospital Heart and Lung InstituteLouisville

Personalised recommendations