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Diagnosis of AMI
1 Typical symptoms (may not be present)
2 Distinctive ECG (may not be present)
3 Abnormal blood testsndash Troponin-Indash ldquoCKrdquo ldquoCPKrdquo or ldquoCK-Mbrdquo
Definition unstable angina
bull Unstable anginamdashan acute process of myocardial ischemia that is not of sufficient severity and duration to result in myocardial necrosis ndash Do not release biomarkers indicative of
myocardial necrosis into the blood
REQUISITI PER UN MARCATORE DI LESIONE DEL MIOCARDIO ldquoIDEALErdquo
Presente in elevate concentrazioni nel muscolo cardiaco
Contenuto unicamente nella cellula miocardica
(SPECIFICITArsquo ASSOLUTA)
Assenza dal circolo in condizioni di normalitagrave
(ESTREMAMENTE SENSIBILE E PRECISO)
Rilasciato dal muscolo cardiaco danneggiato rapidamente
in maniera completa ed in quantitarsquo proporzionale al
danno miocardico
Rilevabile nel plasma in una finestra diagnostica utile a
porre diagnosi sia precocemente che tardivamente
Validato dai trials clinici
Saggio ampiamente disponibile e poco costoso
A causa della loro scarsa sensibilitarsquo e specificitarsquo
le determinazioni di aspartato amminotransferasi (AST)
lattato deidrogenasi (LDH) totale e suoi isoenzimi
CK totale ed attivitarsquo catalitica del suo isoenzima MB
dovrebbero essere considerate come obsoletePanteghini M et al G Ital Cardiol 199929810
Tools Cardiac Markers for AMI DiagnosisCreatine Kinase MB isoenzyme (CK-MB)
Myocardial specific
4-10 hrs to achieve diagnostic performance
2-3 days to return to normal
Myoglobin 2-3 hrs to achieve diagnostic
performance24 hrs to return to normal
Not specific abundant in skeletal muscle
Troponin T or I (TnT TnI)Myocardiac specificUp to 12 hrs to achieve diagnostic
performance
Several days to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Definition unstable angina
bull Unstable anginamdashan acute process of myocardial ischemia that is not of sufficient severity and duration to result in myocardial necrosis ndash Do not release biomarkers indicative of
myocardial necrosis into the blood
REQUISITI PER UN MARCATORE DI LESIONE DEL MIOCARDIO ldquoIDEALErdquo
Presente in elevate concentrazioni nel muscolo cardiaco
Contenuto unicamente nella cellula miocardica
(SPECIFICITArsquo ASSOLUTA)
Assenza dal circolo in condizioni di normalitagrave
(ESTREMAMENTE SENSIBILE E PRECISO)
Rilasciato dal muscolo cardiaco danneggiato rapidamente
in maniera completa ed in quantitarsquo proporzionale al
danno miocardico
Rilevabile nel plasma in una finestra diagnostica utile a
porre diagnosi sia precocemente che tardivamente
Validato dai trials clinici
Saggio ampiamente disponibile e poco costoso
A causa della loro scarsa sensibilitarsquo e specificitarsquo
le determinazioni di aspartato amminotransferasi (AST)
lattato deidrogenasi (LDH) totale e suoi isoenzimi
CK totale ed attivitarsquo catalitica del suo isoenzima MB
dovrebbero essere considerate come obsoletePanteghini M et al G Ital Cardiol 199929810
Tools Cardiac Markers for AMI DiagnosisCreatine Kinase MB isoenzyme (CK-MB)
Myocardial specific
4-10 hrs to achieve diagnostic performance
2-3 days to return to normal
Myoglobin 2-3 hrs to achieve diagnostic
performance24 hrs to return to normal
Not specific abundant in skeletal muscle
Troponin T or I (TnT TnI)Myocardiac specificUp to 12 hrs to achieve diagnostic
performance
Several days to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
REQUISITI PER UN MARCATORE DI LESIONE DEL MIOCARDIO ldquoIDEALErdquo
Presente in elevate concentrazioni nel muscolo cardiaco
Contenuto unicamente nella cellula miocardica
(SPECIFICITArsquo ASSOLUTA)
Assenza dal circolo in condizioni di normalitagrave
(ESTREMAMENTE SENSIBILE E PRECISO)
Rilasciato dal muscolo cardiaco danneggiato rapidamente
in maniera completa ed in quantitarsquo proporzionale al
danno miocardico
Rilevabile nel plasma in una finestra diagnostica utile a
porre diagnosi sia precocemente che tardivamente
Validato dai trials clinici
Saggio ampiamente disponibile e poco costoso
A causa della loro scarsa sensibilitarsquo e specificitarsquo
le determinazioni di aspartato amminotransferasi (AST)
lattato deidrogenasi (LDH) totale e suoi isoenzimi
CK totale ed attivitarsquo catalitica del suo isoenzima MB
dovrebbero essere considerate come obsoletePanteghini M et al G Ital Cardiol 199929810
Tools Cardiac Markers for AMI DiagnosisCreatine Kinase MB isoenzyme (CK-MB)
Myocardial specific
4-10 hrs to achieve diagnostic performance
2-3 days to return to normal
Myoglobin 2-3 hrs to achieve diagnostic
performance24 hrs to return to normal
Not specific abundant in skeletal muscle
Troponin T or I (TnT TnI)Myocardiac specificUp to 12 hrs to achieve diagnostic
performance
Several days to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
A causa della loro scarsa sensibilitarsquo e specificitarsquo
le determinazioni di aspartato amminotransferasi (AST)
lattato deidrogenasi (LDH) totale e suoi isoenzimi
CK totale ed attivitarsquo catalitica del suo isoenzima MB
dovrebbero essere considerate come obsoletePanteghini M et al G Ital Cardiol 199929810
Tools Cardiac Markers for AMI DiagnosisCreatine Kinase MB isoenzyme (CK-MB)
Myocardial specific
4-10 hrs to achieve diagnostic performance
2-3 days to return to normal
Myoglobin 2-3 hrs to achieve diagnostic
performance24 hrs to return to normal
Not specific abundant in skeletal muscle
Troponin T or I (TnT TnI)Myocardiac specificUp to 12 hrs to achieve diagnostic
performance
Several days to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Tools Cardiac Markers for AMI DiagnosisCreatine Kinase MB isoenzyme (CK-MB)
Myocardial specific
4-10 hrs to achieve diagnostic performance
2-3 days to return to normal
Myoglobin 2-3 hrs to achieve diagnostic
performance24 hrs to return to normal
Not specific abundant in skeletal muscle
Troponin T or I (TnT TnI)Myocardiac specificUp to 12 hrs to achieve diagnostic
performance
Several days to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Myoglobin
Rapid riseNon-specificCannot be used alone to confirm MI
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
CPK-MB
15 of cardiac CPK small amount in skeletal muscle
MB-Mass Validated as marker for MIHowever Can increase after muscle injury muscular
diseases Can be found in tongue intestine
diaphragm uterus prostate
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Le Troponine cardiacheLe Troponine cardiache
Sono costituite da un eterotrimero suddiviso
in 3 sub-unitagrave
bull Troponina C 18 kD deputata a legare ioni Ca++
bull Troponina I 22 kD con funzione inibitoria
bull Troponina T 37 kD con funzione di legame alla tropomiosina
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Figure 1 Plot of the appearance of cardiac markers in blood vs time after onset of symptoms Peak A early release of myoglobin or CK-MB isoforms after AMI peak B cardiac troponin after AMI peak C CK-MB after AMI peak D cardiac troponin after unstable angina Data are plotted on a relative scale where 10 is set at the AMI cutoff concentration
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
New and old diagnostic criteria for MI
2 of 3
Elevated cardiac markers Trop or CK and CKMB
Evidence of myocardial damage as assessed by pathologic exam ECG or imaging modalityOne of
the following
WHO Criteria for Diagnosis of MI
ESC ACC Recommendations for diagnosis of MI
Chest pain
ECG changes
Serum markers
Alpert et al - ACC Consensus JACC 2000 36 959 - 969
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Cardiac Analyzer 2nd and 3rd Specimens 6hrs and 12hrs
Second or third specimen
Measure CKMB
Previous
Troponin gt
99th percentile
Measure
troponin
Troponin
gt 30 ngml
Cancel remaining tests
Continue
test algorithm
No
Yes
Yes
Delta
CKMB gt 20
No Measure
troponin
Yes
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
The Future
bull Early indicators of plaque instability
bull Early indicators of thrombotic activity
bull Markers for IIbIIIa sensitivity
bull Indicators of cytokine activation
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Technology in the Future Family of Near-Patient Diagnostic Sensors
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Human protein P05413 - Fatty acid-binding protein heart (H-FABP) (Heart-type fatty acid- binding protein) (Muscle fatty acid-binding protein) (M-FABP) (Mammary-derived growth inhibitor) (MDGI) EMBL
Normalized expression distribution for tissue type Top ten
Tissue Normalized
Expression () Cluster Clones
Tissue clones Heart 3995 1335504
Muscle 2162 1890826
Lung 814 17227901
Uterus 594 7128533
Peripheral_Nervous_System 519 121019
Testis 507 5107669
Kidney 287 3113979
Brain 239 7319574
Bone 213 151252
Prostate 113 196523
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
Tools FABP in AMI Diagnosis
FABP CharacteristicsSmall cytoplasmic protein abundant in heart and muscle
Cardiac specific isoforms
Normal levels below 1ngml
Most sensitive early cardiac marker
lt3 hrs to achieve diagnostic performance
12-24 hrs to return to normal
