Myocardiac markers

Myocardial Injury Detection Dr. B. K. Iyer

Myocardial injury ,[object Object],[object Object],After 30-60 min, cell death starts 80% of cells at risk die within 3 hours Almost 100% by 6 hours of ischemia ,[object Object]

[object Object],100 50 0 Fraction of ischemic cells already dead 0 1 2 3 4 5 6 Hours of Ischemia ,[object Object]

[object Object],Plaque ,[object Object],CLOT ,[object Object],[object Object],[object Object],[object Object],Crescendo Angina ANGINA

Acute coronary syndrome ,[object Object]

MI Diagnosis - WHO criteria ,[object Object],[object Object],[object Object]

MI Diagnosis - WHO criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Markers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Criteria of Ideal marker ,[object Object],[object Object],[object Object],What is an ideal cardiac marker?

Ideal cardiac marker ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Myocardial contents ,[object Object],Myoglobin Actin, Myosin Troponin LDH CK, AST

Myocardial contents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Myocardial contents ,[object Object],[object Object],[object Object]

Myocardial injury markers Cardiac enzymes Non enzymes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Which markers? ,[object Object],[object Object]

Which markers? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Which markers? ,[object Object],[object Object],[object Object]

Clinical significance ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical significance ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TnI Actin Tropomyosin TnC TnT

Myocardial markers ,[object Object],Troponin Myoglobin CK, AST LDH Normal ,[object Object],[object Object],[object Object],[object Object]

Sensitivity ,[object Object],Size of Myocardial Infarction (grams ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sensitivity Wasimuddin et al. Crit Care Med, 1994 6 557 PAIN < 30 min NO ECG CHANGE 16 551 PAIN > 30 min OR ECG CHANGE 49 312 PAIN > 30 min, ECG CHANGE 20 1420 ANY CHEST PAIN % MI NUMBER CATEGORY

Sampling frequency ,[object Object],[object Object],[object Object],[object Object]

Cardiac protein changes with thrombolysis / Reperfusion ,[object Object],[object Object],RELATIVE CONCENTRAITON TIME AFTER INFARCTION Successful thrombolysis Normal MI, unsuccessful thrombolysis

MI >48 hrs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MI >48 hrs ,[object Object],[object Object],[object Object],[object Object]

Release mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object]

Release mechanism ,[object Object],[object Object]

Myoglobin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Creatine kinase ,[object Object],[object Object],[object Object],[object Object]

Creatine kinase ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CK MB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CK MB isoforms ,[object Object],[object Object],[object Object]

Troponin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Troponin significance ,[object Object],[object Object],[object Object],[object Object]

Troponin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Troponin T (TnT) ,[object Object],[object Object],[object Object],[object Object]

Troponin I (TnI) ,[object Object],[object Object],[object Object]

Tn in renal failure ,[object Object],[object Object],[object Object],[object Object]

Problems with TnI ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Problems with TnI

New Markers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Early markers of cardiac injury

Early markers ,[object Object],[object Object],[object Object]

hFABP ,[object Object],[object Object]

hFABP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Is hFABP new? ,[object Object],[object Object]

FA metabolism depends on Transport Uptake Delivery to intracellular sites of β -oxidation The insoluble FA bound to special carriers to enhance their rate of transport and cellular uptake Plasma triglycerides serve to supplement FA transport Plasma albumin augments circulatory transport by increasing FA binding sites and binding of non-esterified FAs Fatty acid metabolism

FABP types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],FABP levels in AMI and UAP at admission and one hour later

Why is hFABP earlier? ,[object Object],[object Object],Pflügers Arch – Eur J Physiol (2000) 439:416–422

Why is hFABP earlier? ,[object Object],[object Object]

Is hFABP earlier than myoglobin? ,[object Object],[object Object],[object Object]

Why is hFABP more specific than myoglobin? ,[object Object],[object Object]

Does hFABP detect stable angina also? ,[object Object],[object Object],[object Object]

Is hFABP testing an ELISA test? ,[object Object],[object Object]

What is sensitivity in hFABP testing? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Can false positives occur in hFABP testing? ,[object Object],[object Object],[object Object]

In case of false +ve with hFABP, what is done? ,[object Object],[object Object]

What is specificity in hFABP testing? ,[object Object],[object Object],[object Object],[object Object]

Can false negatives occur in hFABP testing? ,[object Object],[object Object],[object Object]

Any medications interfere with hFABP testing? ,[object Object]

Emerging Markers ,[object Object],[object Object],[object Object],[object Object]

Myocardiac markers

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Myocardiac markers