CARDIAC
BIOMARKERS
- Divya Thakkar
20187
Definition :
A biomarker is defined as a naturally
occuring molecule, gene or charactetistic
by which a particular pathological process
or disease can be identified.
Cardiacbiomarkers (Group 3 tests) are
markers of cardiac injury, released when
the cardiac muscle undergoes necrosis.
List of tests:
Cardiac troponins (cTnT and cTnI)
High sensitivity troponins (hs-cTnT and hs-cTnI)
Creatinine kinase isoenzyme (CK MB)
Brain Natriuretic peptide (BNP) or NT- Pro BNP
Lactate dehydrogenase (LDH)
Aspartate aminotransferase (AST or SGOT)
Myoglobin
Indications for testing cardiac
markers:
Cardiac Troponins
Specific markers of myocardial infarction
Troponin complex 3 components:
1. Troponin I (Inhibitory subunit)
2. Troponin T (Tropomyosin binding subunit)
3. Troponin C (Calcium binding subunit)
Trop I and T have cardiac isoforms, 95
percent are located in myofibrils and
remaining 5 percent in cytoplasm of
cardiac muscles
Troponin I (cTnI)
Released within 4 hrs of onset of
myocardial ischemia
Peaks at 14-24 hrs
Remains elevated for 7-10 days post
infarction
Troponin T (cTnT)
Increases within 6 hrs of myocardial
infarction
Peaks at 72 hours
Remains elevated up to 10–14 days.
Determination of Troponin T (Rapid test)
immunological test by using a Diagnostic kit
Sample : Heparinised or EDTA venous whole blood
Principle:
The test application area contains two monoclonal
antibodies specific for cardiac troponin T. One antibody is
gold labelled and another antibody is biotinylated.
If cTnT is present in the specimen it forms a sandwich
complex with both the antibodies. Plasma passes through
the detection zone and the cTnT sandwich complex present
in it gathers along a line and appears as a red streak.
Excess gold labelled antibodies gather along the control line
Normal values:
Trop T ( cTnT): 0-0.1 ng/mL
Trop I ( cTnI) : 0-0.4 ng/mL
Significance of Troponins:
Specific markers of myocardial infarction
To Confirm diagnosis and know extent of MI
Detects MI even before ECG changes are
noticed
To
differentiate between Unstable angina
and NSTEMI
Prognostic markers
High Sensitivity Cardiac Troponins
(hs-cTnTor hs-cTnI)
Elevated cTn levels also seen in cardiac injury including
acute coronary syndrome (ACS), acute myocardial
infarction (AMI), stroke, pulmonary embolism, sepsis.
acute perimyocarditis, acute heart failure, and tachycardia
:.hs cT are more specific tests to identify MI
2 samples: At presentation and 3 hrs later
Rise of 20-100 percent : Equivocal, needs further
evaluation
Rise >100 percent : MI
Creatine kinase
• Levels start to rise 3-6 hrs after infarct
Peak in 18-24 hrs
Remain elevated 36-48 hrs after infarct
Normal serum value for CK is 15 –100 U/L for
males and 10–80 U/L for females.
Normally CK-MB is only 5% of the total
activity.
Even doubling of the value of CK-MB
isoenzyme may not be detected, if total value
of CK alone is estimate.
Hence the estimation of CK-MB isoenzyme is
important for the diagnosis of myocardial
infarction.
Ratio of CK MB to total CK :
<3: Skeletal muscle source
>5: Cardiac source
Determination of isoenzyme CKMB
(CK 2)
Sample: Serum (free from hemolysis)
Principle: Immunoinhibition
The sample is incubated with anti CK MM
serum to completely inhibit CK MM
(99.5%). The CK MB activity is then
determinant by UV Kinetic method
Uses:
Very useful to detect early cases
Second peak may indicate
another ischemic episode :. Useful
to detect re infarcts.
CK level is not increased in
hemolysis or in congestive cardiac
failure; and therefore CK has an
advantage over LDH.
Area under the peak and slope of
initial rise are proportional to the
Drawbacks:
CK is also elevated in
1. Muscular dystrophy
2. Female carriers of muscular dystrophy
3. Crush injury, fracture and acute
cerebrovascular accidents.
Cannot detect late infarcts if the
patient presents after 48 hr
