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Biomarkers in Myocardial Damage Diagnostics
KOPŘIVOVÁ, Olga
Anotace (abstract) Biomarkers diagnosing myocardial damages have recently been a very dynamically developing part of clinical biochemistry. Implementing of new biomarkers is very prompt; they are mostly implemented into practice without wider clinical and analytical experience. During a few years these are new methods to determine myoglobin, troponins (cTnI, cTnT), CK-MB mass, BNP etc. The effort of clinical biochemists and cardiologists is to cover all phases and levels of myocardial damage in acute coronary syndromes by means of cardio markers. These investigations are dramatically changing the view of diagnosis, determination of prognosis and therapy in acute coronary syndromes. In my thesis I covered retrospective data analysis in patients with the pain in the chest, presented at an inpatient clinic. The value of myocardial damage indicators and their dynamism was analysed from the definitive diagnosis point of view. I performed my own analysis at OKB Nemocnice Písek, a.s. (Hospital Písek, Inc.). The aim of my thesis was to cover the significance of particular myocardial damage markers and find out if investigated set of markers is sufficient for correct and prompt diagnosis of acute myocardial infarction. In terms of this thesis I tried to find out if the panel of cardiac markers contains excess values. In OKB Písek, a.s. the panel of myocardial damage markers includes: myoglobin, troponin I, CK-MB mass and the marker of heart failure BNP. In the samples of fifty-six patients I analysed the presence of the above mentioned markers of myocardial damage and heart failure. I examined only the markers which were determined by a physician. In the group of investigated patients with chest pain, measured values of troponins proved myocardial infarction in sixteen patients, values of CK-MB mass in sixteen patients and values of myoglobin in twelve patients. In the control group of twenty patients with chest pain the boundary values of troponin I were measured in two patients, without the increase of other myocardial damage markers. High value of troponin I was measured in two patients in non-ischemic myocardial damage (acute pericarditis), which agrees with data in scientific literature. The thesis shows that the level of troponin I reflects myocardial damage relatively accurately; troponin I is sufficiently cardio specific but is not a sufficiently early marker. For early management of acute myocardial infection it is important to determine myoglobin, which is detectable within two hours since the beginning of troubles but is not sufficiently cardio specific. The course of CK-MB mass elevation wave copies the course of troponin I elevation wave. That is why the investigation of this marker appears to be excessivet at current investigation of troponin I and myoglobin to prove myocardial damage, which is in agreement with scientific association recommendations.
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