Advertisement

Diagnostic and prognostic role of myoglobin in patients with suspected acute coronary syndrome∗

      Biochemical markers are the primary diagnostic test used to evaluate patients with inconclusive electrocardiograms for possible acute coronary syndrome. Measurements of cardiac enzymes allow a clear distinction between patients with and without myocardial infarction.
      • Bhayana V
      • Henderson A.R
      Biochemical markers of myocardial damage.
      ,
      World Health Organization
      Nomenclature and criteria for diagnosis of ischemic heart disease.
      For many years, creatine kinase (CK) and its isoenzyme MB have been the markers of choice for diagnosing acute myocardial infarction. Troponins T and I are markers with high specificity for cardiac cell damage and have been established as definite markers for cell injury.
      • Bodor G.S
      • Porter S
      • Landt Y
      • Ladenson J.H
      Development of monoclonal antibodies for an assay of cardiac troponin I and preliminary results in suspected cases of myocardial infarctions.
      ,
      • Katus H.A
      • Remppis A
      • Neumann F.J
      • Scheffold T
      • Diederich K.W
      • Vinar G
      • Noe A
      • Matern G
      • Kübler W
      Diagnostic efficiency of troponin T measurements in acute myocardial infarction.
      In patients with unstable angina,
      • Braunwald E
      Unstable angina. A classification.
      these markers have been valuable in predicting short- and long-term risk for severe cardiac events.
      • Hamm C.W
      • Goldmann B.U
      • Heeschen C
      • Kreymann G
      • Berger J
      • Meinertz T
      Emergency room triage of patients with acute chest pains by means of rapid testing for cardiac troponin T or troponin I.
      ,
      • Lindahl B
      • Venge P
      • Wallentin L.L
      FRISC Study Group
      Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease.
      ,
      • Möckel M
      • Störk T
      • Heller Jr, G
      • Röcker L
      • Danne O
      • Darrelmann G.R.J
      • Eichstädt H
      • Frei U
      Troponin T in patients with low grade or atypical angina. Identification of a high risk group for short-term and long-term cardiovascular events.
      ,
      • Newby L.K
      • Christenson R.H
      • Ohman M
      • Armstrong P.W
      • Thompson T.D
      • Lee K.L
      • Hamm C.W
      • Katus H.A
      • Ciancolo C
      • Granger C.B
      • Topol E.J
      • Califf R.M
      GUSTO-IIa Investigators
      Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes.
      Currently, myoglobin, due to its rapid kinetic release, most effectively fits the role as an early marker.
      • Störk T
      • Möckel M
      • Danne O
      • Abraham K
      • Müller R
      • Frei U
      Myoglobin for diagnosis of infarction and reperfusion under clinical conditions.
      ,
      • Panteghini M
      • Apple F.S
      • Christenson R.H
      • Dati F
      • Mair J
      • Wu A.H
      Proposals from IFCC Committee on Standardization of Markers of Cardiac Damage (C-SMCD) recommendations on use of biochemical markers of cardiac damage in acute coronary syndromes.
      ,
      • Wu A
      • Apple F.S
      • Gibler W.B
      • Jesse R.L
      • Warshaw M.M
      • Valdes Jr, R
      Standards of laboratory practice. Recommendations for use of cardiac markers in coronary artery disease.
      The Committee on Standardization of Markers of Cardiac Damage of the International Federation of Clinical Chemistry (IFCC)
      • Panteghini M
      • Apple F.S
      • Christenson R.H
      • Dati F
      • Mair J
      • Wu A.H
      Proposals from IFCC Committee on Standardization of Markers of Cardiac Damage (C-SMCD) recommendations on use of biochemical markers of cardiac damage in acute coronary syndromes.
      and the National Academy of Clinical Biochemistry (NACB)
      • Wu A
      • Apple F.S
      • Gibler W.B
      • Jesse R.L
      • Warshaw M.M
      • Valdes Jr, R
      Standards of laboratory practice. Recommendations for use of cardiac markers in coronary artery disease.
      have published guidelines for the use of cardiac markers, stating a need for an accelerated protocol for the use of an early marker like myoglobin to diagnose patients with chest pain. The North-Württemberg Infarction Study (NOWIS) has evaluated the diagnostic and prognostic role of myoglobin as an early marker in patients with suspected acute coronary syndrome who had inconclusive electrocardiograms on admission.
      • Störk T
      • Möckel M
      • Gareis R
      • Müller-Bardorff M
      • Linden M
      • Hey D
      • Braun R
      • Müller R
      • Eichstädt H
      • Fröhlich E
      • Frei U
      North-Württemberg Infarction Study (NOWIS) Group
      Troponin T and myoglobin in acute coronary syndromes for diagnosis, risk stratification and ruling out of myocardial infarction. Results of the North-Württemberg Infarction Study (NOWIS).
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bhayana V
        • Henderson A.R
        Biochemical markers of myocardial damage.
        Clin Biochem. 1995; 28: 1-29
        • World Health Organization
        Nomenclature and criteria for diagnosis of ischemic heart disease.
        Circulation. 1979; 59: 607-609
        • Bodor G.S
        • Porter S
        • Landt Y
        • Ladenson J.H
        Development of monoclonal antibodies for an assay of cardiac troponin I and preliminary results in suspected cases of myocardial infarctions.
        Clin Chem. 1992; 38: 2203-2214
        • Katus H.A
        • Remppis A
        • Neumann F.J
        • Scheffold T
        • Diederich K.W
        • Vinar G
        • Noe A
        • Matern G
        • Kübler W
        Diagnostic efficiency of troponin T measurements in acute myocardial infarction.
        Circulation. 1991; 83: 902-912
        • Braunwald E
        Unstable angina. A classification.
        Circulation. 1989; 80: 410-414
        • Hamm C.W
        • Goldmann B.U
        • Heeschen C
        • Kreymann G
        • Berger J
        • Meinertz T
        Emergency room triage of patients with acute chest pains by means of rapid testing for cardiac troponin T or troponin I.
        N Engl J Med. 1997; 337: 1648-1653
        • Lindahl B
        • Venge P
        • Wallentin L.L
        • FRISC Study Group
        Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease.
        Circulation. 1996; 93: 1651-1657
        • Möckel M
        • Störk T
        • Heller Jr, G
        • Röcker L
        • Danne O
        • Darrelmann G.R.J
        • Eichstädt H
        • Frei U
        Troponin T in patients with low grade or atypical angina. Identification of a high risk group for short-term and long-term cardiovascular events.
        Eur Heart J. 1998; 19: 1802-18027
        • Newby L.K
        • Christenson R.H
        • Ohman M
        • Armstrong P.W
        • Thompson T.D
        • Lee K.L
        • Hamm C.W
        • Katus H.A
        • Ciancolo C
        • Granger C.B
        • Topol E.J
        • Califf R.M
        • GUSTO-IIa Investigators
        Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes.
        Circulation. 1998; 98: 1853-1859
        • Störk T
        • Möckel M
        • Danne O
        • Abraham K
        • Müller R
        • Frei U
        Myoglobin for diagnosis of infarction and reperfusion under clinical conditions.
        Lab Med. 1995; 19: 251-259
        • Panteghini M
        • Apple F.S
        • Christenson R.H
        • Dati F
        • Mair J
        • Wu A.H
        Proposals from IFCC Committee on Standardization of Markers of Cardiac Damage (C-SMCD).
        Scan J Clin Lab Invest. 1999; 59: 103-112
        • Wu A
        • Apple F.S
        • Gibler W.B
        • Jesse R.L
        • Warshaw M.M
        • Valdes Jr, R
        Standards of laboratory practice. Recommendations for use of cardiac markers in coronary artery disease.
        Clin Chem. 1999; 45: 1104-1121
        • Störk T
        • Möckel M
        • Gareis R
        • Müller-Bardorff M
        • Linden M
        • Hey D
        • Braun R
        • Müller R
        • Eichstädt H
        • Fröhlich E
        • Frei U
        • North-Württemberg Infarction Study (NOWIS) Group
        Troponin T and myoglobin in acute coronary syndromes for diagnosis, risk stratification and ruling out of myocardial infarction. Results of the North-Württemberg Infarction Study (NOWIS).
        Perfusion. 1999; 12: 488-495
        • Plebani M
        • Zaninotto M
        Diagnostic strategies using myoglobin measurement in myocardial infarction.
        Clin Chim Acta. 1998; 272: 69-75
        • Wu A.B
        • Clive J.M
        Impact of CK-MB testing policies on hospital length stay and laboratory costs for patients with myocardial infarction or chest pain.
        Clin Chem. 1997; 43: 326-333
        • Ohman E.M
        • Casey C
        • Bengston J.R
        • Pryor D
        • Tormey W
        • Horgan I.H
        Early detection of acute myocardial infarction.
        Br Heart J. 1990; 61: 335-338
        • Vuori J
        • Syrjala H
        • Vaanen K
        Myoglobin/carbonic anhydrase III ratio.
        Clin Chem. 1996; 42: 107-109
        • Van Nieuwenhoven F.A
        • Kleine A.H
        • Wodzig K.W.H
        Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid-binding protein.
        Circulation. 1995; 92: 2848-2854
        • Pope H.J
        • Aufderheide T.P
        • Ruthazer R
        • Woolard R.H
        • Feldman J.A
        • Beshansky J.R
        • Griffith J
        • Selker H
        Missed diagnosis of acute cardiac ischemia in the emergency department.
        N Engl J Med. 2000; 342: 1163-1170
        • Möckel M
        • Schindler R
        • Knorr L
        • Müller C
        • Heller Jr, G
        • Störk T.V
        • Frei U
        Prognostic value of cardiac troponin T and I elevations in renal disease patients without acute coronary syndromes.
        Nephrol Dial Transplant. 1999; 14: 1489-1495