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Biomarkers suggesting cardiac injury other than troponins

Allan S Jaffe, MD
David A Morrow, MD, MPH
Section Editors
Christopher P Cannon, MD
Juan Carlos Kaski, MD, DM, DSc, FRCP, FESC, FACC, FAHA
Deputy Editor
Gordon M Saperia, MD, FACC


Cardiac injury can be defined as the disruption of normal cardiac myocyte membrane integrity resulting in the loss into the extracellular space (including blood) of intracellular constituents including detectable levels of a variety of biologically active cytosolic and structural proteins such as troponin, creatine kinase, myoglobin, heart-type fatty acid binding protein, and lactate dehydrogenase. Injury is usually considered irreversible (cell death), but definitive proof that cell death is an inevitable consequence of the process is not available.

Causes of cardiac injury include trauma, toxins, and viral infection, but ischemia or infarction consequent to an imbalance between the supply and demand of oxygen (and nutrients) is the most common cause.

When a sufficient number of myocytes have died (myocyte necrosis) or lost function, acute clinical disease is apparent; examples include myocardial infarction (MI) or myocarditis. (See "Criteria for the diagnosis of acute myocardial infarction" and "Clinical manifestations and diagnosis of myocarditis in adults".)

The biochemical characteristics and utility of myoglobin, fatty acid binding protein, lactate dehydrogenase, and creatine kinase for the diagnosis of and prognosis after acute MI will be reviewed here. Troponins, which are the preferred biomarkers for diagnosis and prognosis, are discussed separately. (See "Troponins as biomarkers of cardiac injury".)


Creatine kinase (CK) and its MB isoenzyme (CK-MB) were the most commonly used serologic tests for the diagnosis of myocardial infarction prior to the widespread adoption of troponin. Their use has markedly diminished over time. They are discussed here predominantly for those areas of the world where cardiac troponin assays are not yet in use. (See "Troponins as biomarkers of cardiac injury".)


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Literature review current through: Oct 2015. | This topic last updated: Oct 20, 2015.
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