Cardiac Biomarkers

OVERVIEW

  • Biomarkers can potentially be used to detect and monitor a wide range of cardiac conditions in the critical care setting
  • currently the only biomarker acceptable for changing management in acute coronary syndrome is the troponin test
  • in the future, a tailored multi-marker approach may have use in guiding diagnosis and therapy – this is a long way off!

POTENTIAL USES OF CARDIAC BIOMARKERS

Myocardial ischaemia

  • Troponin
  • H-FABP
  • ischaemic modified albumin

Thrombosis

  • CRP
  • ESR
  • different binding proteins

Myocardial injury

  • Troponin (level peaks at 12h, proportional to infarct size, but altered by washout phenomenom after reperfusion therapy)
  • CK
  • CK-MB
  • myoglobin
  • AST
  • LDH
  • novel: copeptin (C-terminal provasopressin), BNP/ NTproBNP, GP-BB, myleoperoxidase, pregnancy associated plasma protein A

Inflammation, endothelial activation and neutrophilic activation

  • CRP
  • ESR
  • PaPPA
  • endothelin/ CTproET-1
  • adrenomedullin/ MRproADM
  • myeloperoxidase
  • matrix metalloproteinases (MMP9, MMP2, TIMP1)

Heart failure

  • BNP/ NTproBNP
  • ANP/ N-ANP/ MRproANP
  • Troponin
  • IL18
  • CA125
  • Urocortin

Sepsis-induced myocardial dysfunction

  • Troponin
  • BNP/ NTproBNP

Right ventricular strain in pulmonary embolism

  • Troponin
  • BNP/ NTproBNP

PROS AND CONS OF BIOMARKERS IN ACUTE MYOCARDIAL INFARCTION

References and Links

  • Chan D, Ng LL. Biomarkers in acute myocardial infarction. BMC Med. 2010 Jun 7;8:34. doi: 10.1186/1741-7015-8-34. PMC2898678.
  • McLean AS, Huang SJ, Salter M. Bench-to-bedside review: the value of cardiac biomarkers in the intensive care patient. Crit Care. 2008;12(3):215. PMC2481437.
  • van Kimmenade RR, Januzzi JL Jr. Emerging biomarkers in heart failure. Clin Chem. 2012 Jan;58(1):127-38. PMID: 22086968. [Free Fulltext]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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