Biokemijski markeri ishemije miokarda

master's thesis

• Title (english): Biochemical markers of myocardial ischemia
• Author: Petar Bešlić
• Mentor: Miro Bakula (mentor)
• Committee member: Ante Bilić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Miro Bakula (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2014-03-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Otkrivanje reverzibilne ishemije prije razvoja ireverzibilne nekroze miokarda je
veliki dijagnostički i terapijski izazov. Ukoliko bi se prolazna ishemija mogla otkriti
biokemijski, rana terapijska intervencija mogla bi spriječiti progresiju do mionekroze.
Oko 40 % bolesnika s akutnim koronarnim sindromom (AKS) ne razvije nekrozu
unatoč izraženoj koronarnoj bolesti i kardijalnoj ishemiji. Sekvencijsko određivanje
troponina uz snimanje elektrokardiograma (EKG) vrlo je osjetljiva metoda za
dijagnostiku infarkta miokarda, ali ne i za prepoznavanje ishemije. Stoga je razumljiva
znanstvena težnja za otkrivanjem ranog markera ishemije miokarda mjerljivog prije
razvoja nekroze koju danas otkrivamo porastom troponina tek nakon četiri sata.
Dosadašnja istraživanja ističu nekoliko različitih markera kojima je zajednička
osobina promptni porast u ishemijskom okruženju (pet minuta do tri sata) te brz
povratak na normalu (tri do 24 sata). Najperspektivnijim se čine ishemijom
modificirani albumin (IMA), glikogen fosforilaza izoenzim BB (GPBB), nevezane
slobodne masne kiseline (FFAU) i njihov specifični srčani protein koji veže masne
kiseline (H-FABP), kolin i kopeptin. Uvođenje biokemijskih markera ishemije
miokarda u kliničku praksu zahtijeva dodatnu evaluaciju. Za većinu ne postoje
standardizirani analitički postupci, istraživanja za referentne intervale, niti ujednačene
kliničke evaluacije. Uz to, nespecifični su za miokard budući da i druga ishemijom
zahvaćena tkiva mogu biti izvorište navedenih markera. Zbog svega toga je njihova
vrijednost u otkrivanju ishemije miokarda ograničena i za sada nisu primjenjivi u
rutinskoj kliničkoj praksi.

Abstract (english)

Diagnosis of reversible ischaemia before the development of irreversible
necrosis of myocytes is a great diagnostic and therapeutic challenge. If transient
ischemia could be detected biochemically, early therapeutic intervention could stop
progression of myonecrosis. Approximately 40% of patients with ACS does not
develop necrosis despite severe coronary artery disease and myocardial ischaemia.
The combination of serial troponin levels and ECG are very sensitive markers for
detection of myocardial infarction, but they do not detect ischemia. Therefore, there is
a reasonable scientific tendency to reveal markers which could reliably detect
ischaemia even in the absence of necrosis which is diagnosed as late as after four
hours by troponin level increase. Several biomarkers currently under investigation
tend to be short-lived, increase promptly or within 3 h, and return to reference value
within 3-24 h. The most promising of them are ischemia-modified albumin (IMA),
glycogen phosphorylase BB (GPBB), unbound free fatty acid (FFAU) and their
intracellular binding protein, heart-type fatty acid-binding protein (H-FABP), choline
and copeptin. However, their application in the clinic requires further evaluation. Most
of them are not standardized lab tests, lack reference interval evaluations or
consistent assay validation. Moreover, none of them is specific to the myocardium
since other organs can also be the origin of these biomarkers. Therefore, their use
in detecting ischemia is limited. At present, none of these biomarkers are appropriate
for routine clinical use.

• Keywords: biokemijski markeri; ishemija miokarda; akutni koronarni sindrom; ishemijom modificirani albumin; kolin; kopeptin; slobodne masne kiseline; glikogen fosforilaza BB; srčani protein koji veže masne kiseline
• Keywords (english): biochemical markers; myocardial ischemia; acute coronary syndrome; ischemia modified albumin; choline; copeptin; glycogen phosphorylase BB; unbound free fatty acids; heart type fatty acid-binding protein
• Language: croatian
• URN:NBN: urn:nbn:hr:105:399133
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-12-09 13:41:42