Akut Koroner Sendrom ve Kardiyak Belirteçler

Year 2016, Volume: 5 Issue: 1, 67 - 73, 01.04.2016

Zeynep Aksungur Yusuf Türköz

Abstract

Akut koroner sendrom ACS , hassas plağın yüzeyel erezyonu/rüptürü ile bu alanda gelişen trombüsün yol açtığı tablodur ve anginadan Q dalgalı miyokard infarktüsüne MI kadar akut miyokard iskemi spekturumuna giren sendromları kapsar. ACS’ların ortak nedeni “trombüs”oluşumudur. Patogenezde; endotelin, intraselüler adezyon molekülü ICAM , nitrik oksid NO , plazminojen aktivatör inhibitörü PAI , doku plazminojen aktivatörü t-PA , trombomodülin, vasküler hücre adezyon molekülü VCAM rol alır. Akut MI’da, koroner damarın tam tıkanmasını ve göğüs ağrısını takip eden ilk 20. dk’dan sonra hücresel düzeyde geriye dönüşümsüz değişiklikler meydana gelir. Klinik olarak, göğüs ağrısını takip eden ilk 1-6. saatler arası hastanın hayata döndürülmesi açısından çok önemlidir, ancak hastaya etkin bir tıbbi müdahalenin altın saati ise, göğüs ağrısını takip eden ilk 1. saat olarak kabul edilir. ACS’u erkenden tanısını koyup gerekli müdahaleyi yapmak için çeşitli yeni belirteçlerin araştırılmaları yapılmış ama henüz net bir sonuca varılamamıştır. Bu derlemede, yeni kardiyak belirteçler konusunda yayımlanan makaleler taranarak elde edilen veriler ışığında bu konu özetlenmeye çalışılmıştır

Keywords

Akur Koroner Sendrom, Kardiyak Belirteçler

Acute Coronary Syndrome and Cardiac Markers

Abstract

Acute coronary syndrome ACS , is a situation because of superficial erosion / rupture of the precision vulnarabl plaque and in this area caused by the developing thrombus. ACS has some syndromes which include the angina to Q-wave Myocardial Infaction MI that they are evaluated in acute myocardial ischemia spectrum. Common cause of ACS is 'Thrombus' formation. Endothelin, Intra-Cellular Adhesion Molecule ICAM , Nitric Oxide NO , Plasminogen activator inhibitor PAI , Tissue Plasminogen Activator tPA , thrombomodulin and Vascular cell adhesion molecule VCAM takes the role in the pathogenesis of ACS. During Acute MI, the complete blockage of the coronary arteries and chest pain after the following first 20 min the irreversible changes occur at the cellular level. Clinically, after the chest pain following the first 1-6. between the hours it is very important to keep alive the patients. But the gold hour for the effective medical intervention is considered to be first 1 hours after the chest paint. Some investigation of a variety new markers has been made to put the early diagnosis of ACS and make necessary interventions; but has not yet reached a clear conclusion. The literature on the new cardiac markers are made on and is intended to create awareness about the new markers. In this review, it has tried to summarize this issue in the light of new data obtained from the published literature on cardiac markers

Keywords

Acute Coronary Syndrome, And Cardiac Markers

References

• 1. Ray KK, Cannon CP. The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes. J Am Coll Cardiol 2005; 46: 1425- 33.
• 2. Nigam PK. Biochemical markers of myocardial injury. IND J Clin Biochem 2007; 1: 10-17.
• 3. Scirica BM, Morrow DA, Cannon CP et al. Clinical application of C-reactive protein across the spectrum of acute coronary syndromes. Clin Chem 2007; 53:1800-7.
• 4. Yasojma K, Schwab C, McGeer EG et al. Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158: 1039-51.
• 5. Pearson T, Mensah GA, Alexander RW et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499-511.
• 6. Crea F, Liuzzo G. Pathogenesis of acute coronary syndromes. J Am Coll Cardiol 2013; 61: 1-11.
• 7. Ridker PM. From C-Reactive Protein to Interleukin-6 to Interleukin-1: Moving Upstream To Identify Novel Targets for Atheroprotection. Circ Res 2016; 118: 145-56.
• 8. Lindmark E, Diderholm E, Wallentin L et al. Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy. J Am Med Assoc 2001; 286: 2107-13.
• 9. Ridker PM , Rifai N, Pfeffer M. et al. Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 2000; 101: 2149-53.
• 10. Cesari M, Penninx BW, Newman AB. et al. Inflammatory markers and onset of cardiovascular events: results from the Health ABC study. Circulation 2003; 108: 2317-22.
• 11. Nicholls SJ, Hazen SL. Myeloperoxidase and cardiovascular disease. Arterioscler Thromb Vasc Biol 2005; 25: 1102-11.
• 12. Blankenberg S, Rupprecht HJ, Poirier O. et al. Plasma concentrations and genetic variation of matrix metalloproteinase 9 and prognosis of patients with cardiovascular disease.Circulation 2003; 107: 1579-85.
• 13. Lubos E, Schnabel R, Rupprecht HJ et al. Prognostic value of tissue inhibitor of metalloproteinase-1 for cardiovascular death among patients with cardiovascular disease: results from the AtheroGene study. Eur Heart J 2006; 27: 150-6.
• 14. Cavuşoğlu E, Ruwende C, Chopra V. et al. Tissue inhibitor of metalloproteinase-1 (TIMP-1) is an independent predictor of all-cause mortality, cardiac mortality, and myocardial infarction. Am Heart J 2006; 151: 1101.
• 15. O’Brein KD, Allen MD, McDonald TO. et al. Vascular cell adhesion molecule-1 is expressed in human coronary atherosclerotic plaques. Implications for the mode of progression of advanced coronary atherosclerosis. J Clin Invest 1993; 92: 945-51.
• 16. Henn V, Steinbach S, Buchner K et al. The inflammatory action of CD40 ligand (CD154) expressed on activated human platelets is temporally limited by coexpressed CD40. Blood 2001; 98: 1047-54.
• 17. Heeschen C, Dimmeler S, Hamm CW. et al. Soluble CD40 ligand in acute coronary syndromes. N Engl J Med 2003; 348:1104-11.
• 18. Varo N, de Lemos JA, Libby P et al. Soluble CD40L: risk prediction after acute coronary syndromes. Circulation 2003; 108: 1049-52.
• 19. Schönbeck U, Varo N, Libby P et al. Soluble CD40L and cardiovascular risk in women. Circulation 2001; 104: 2266-8.
• 20. Syngelaki A, Kotecha R, Pastides A. et al. Firsttrimester biochemical markers of placentation in screening for gestational diabetes mellitus. Metabolism. 2015; 64: 1485-9.
• 21. Overgaard MT, Oxvig C, Christiansen M. et al. Messenger ribonucleic acid levels of pregnancyassociated plasma protein-A and the proform of eosinophil major basic protein: expression in human reproductive and nonreproductive tissues. Biol Reprod 1999; 61: 1083-89.
• 22. Wald N, Stone R, Cuckle HS et al. First trimester concentrations of pregnancy associated plasma protein A and placental protein 14 in Down's syndrome. BMJ 1992; 305: 28.
• 23. Oxvig C, Sand O, Kristensen T. et al. Circulating human pregnancy-associated plasma protein-A is disulfide-bridged to the proform of eosinophil major basic protein. J Biol Chem 1993; 268: 12243-46.
• 24. Overgaard MT, Glerup S, Boldt HB. et al. Inhibition of proteolysis by the proform of eosinophil major basic protein (proMBP) requires covalent binding to its target proteinase. FEBS lett 2004; 560(1-3): 47-52.
• 25. Chiang TM. Activation of phospholipase D in human platelets by collagen and thrombin and its relationship to platelet aggregation. Biochim Biophys Acta 1994; 1224(1): 147-55.
• 26. Kehl DW, Iqbal N, Fard A et al. Biomarkers in acute myocardial injury. Transl Res 2012; 159: 252-64.
• 27. Peacock F, Morris DL, Anwaruddin S et al. Metaanalysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J 2006; 152: 253-62.
• 28. Danne O, Möckel M, Lueders C et al. Prognostic implications of elevated whole blood choline levels in acute coronary syndromes. Am J Cardiol 2003; 91: 1060-67.
• 29. Dobric M, Ostojic M, Giga V. et al. Glycogen phosphorylase BB in myocardial infarction. Clin Chim Acta 2015; 438: 107-11.
• 30. Bozkurt S, Kaya EB, Okutucu S. Et The diagnostic and prognostic value of first hour glycogen phosphorylase isoenzyme BB level in acute coronary syndrome. Cardiol J 2011; 18: 496-502.
• 31. Willemsen RT, van Severen E, Vandervoort PM. et al. Heart-type fatty acid binding protein (HFABP) in patients in an emergency department setting, suspected of acute coronary syndrome: optimal cut-off point, diagnostic value and future opportunities in primary care. Eur J Gen Pract 2015; 21: 156-63.
• 32. Pelsers MM, Hanhoff T, Van der Voort D et al. Brain- and heart-type fatty acid-binding proteins in the brain: tissue distribution and clinical utility. Clin Chem 2004; 50: 1568-75.
• 33. Tambara K, Fujita M, Miyamoto S et al. Pericardial fluid level of heart-type cytoplasmic fatty acid-binding protein (H-FABP) is an indicator of severe myocardial ischemia. Int J Cardiol 2004; 93: 281-4.
• 34. de Groot MJ, Wodzig KW, Simoons ML et al. Measurement of myocardial infarct size from plasma fatty acid-binding protein or myoglobin, using individually estimated clearance rates. Cardiovasc Res 1999; 44: 315-24.
• 35. Bhayana V, Henderson AR. Biochemical markers of myocardial damage. Clin Biochem 1995; 28: 1- 29.
• 36. Vuotikka P, Uusimaa P, Niemelä M et al. Serum myoglobin/carbonic anhydrase III ratio as a marker of reperfusion after myocardial infarction. Int J Cardiol 2003; 91: 137-44.
• 37. M. Kemp , J. Donovan , H. Higham. et al. Biochemical markers of myocardial injury. Br J Anaesth 2004; 93: 63-73.
• 38. Sathyamurthy I, Dalal JJ, Sawhney JP. et al. Cardiac Biomarkers for Better Management of Acute Coronary Syndromes. J Assoc Physicians India 2015; 63: 46-50.
• 39. Katrukha AG, Bereznikova AV, Filatov VL. et al. Degradation of cardiac troponin I: implication for reliable immunodetection. Clin Chem 1998; 44: 2433-40.
• 40. Gerhardt W, Nordin G, Herbert AK. et al. Troponin T and I assays show decreased concentrations in heparin plasma compared with serum: lower recoveries in early than in late phases of myocardial injury. Clin Chem 2000; 46: 817-21.
• 41. Prof. Dr. Zeki Öngen. Akut Koroner Sendromlar: Kavramı, Sınıflaması, Risk Düzeyi Belirlemesi ve Tedavi ilkeleri. Kardiyoloji Gündemi Sempozyum Dizisi No: 64 Nisan 2008; s. 103-12.
• 42. Chawla R, Goyal N, Calton R, Goyal S. Indian J Clin Biochem 2006; 21(1): 77-82