Rodriguez-Ospina Luis F, Rosales-Alvarez Claudia P, Lopez-Mas Alejandro
Cardiology Section, Department of Medicine, VA Caribbean Healthcare System, Puerto Rico.
Bol Asoc Med P R. 2009 Oct-Dec;101(4):15-22.
The traditional diagnosis of myocardial infarction relies primarily within the exhibited patient's clinical presentation, electrocardiographic changes, and elevation in cardiac markers. Since the clinical presentation can be highly variable and EKG changes are not readily present for all patients, the use of markers of cardiac injury to support the diagnosis of myocardial infarction has become a fundamental part of the evaluation of a patient with suspected acute coronary syndrome. In 2007 the Joint European Society of Cardiology/ American College of Cardiology Committee for the Redefinition of Myocardial Infarction concluded that the main criteria for myocardial infarction should be a rise or fall of cardiac biomarkers (namely cardiac troponins and CK-MB) along with: (1) ischemic symptoms, (2) ischemic changes in EKG, (3) Q waves in EKG, or (4) imaging evidence of loss of myocardial viability or (5) wall motion abnormalities. These changes have increased search interests for more sensitive and specific markers of acute myocardial injury; furthermore, dedicated research has commenced in order to specifically allocate markers that could even predict myocardial ischemia. Therefore this article will review traditional employment of cardiac markers, providing current insight, information and experimental data with respect to emerging markers of myocardial ischemia.
心肌梗死的传统诊断主要依赖于患者表现出的临床症状、心电图变化以及心脏标志物升高。由于临床表现可能高度多变,且并非所有患者都会出现明显的心电图变化,因此使用心脏损伤标志物来辅助诊断心肌梗死已成为疑似急性冠脉综合征患者评估的重要组成部分。2007年,欧洲心脏病学会/美国心脏病学会心肌梗死重新定义联合委员会得出结论,心肌梗死的主要标准应为心脏生物标志物(即心肌肌钙蛋白和肌酸激酶同工酶)升高或降低,同时伴有:(1)缺血症状,(2)心电图缺血性改变,(3)心电图Q波,或(4)心肌存活能力丧失的影像学证据,或(5)室壁运动异常。这些变化增加了对更敏感、更特异的急性心肌损伤标志物的研究兴趣;此外,专门的研究已经展开,以确定甚至能够预测心肌缺血的标志物。因此,本文将回顾心脏标志物的传统应用,提供有关心肌缺血新标志物的当前见解、信息和实验数据。