New Biochemical Markers of Ischemia:The Diagnostic and Prognostic Role of Brain Natriuretic Peptide, C-Reactive Protein, Ischemia Modified Albumin & Myeloperoxidase


  • Spyridon Koulouris
  • Stylianos Tzeis
  • Antonis S. Manolis



KEY WORDS, acute coronary syndromes, inflammation, risk stratification, chest pain, biomarkers


The traditional biomarkers, CK-MB and troponins, used for the diagnosis of myocardial ischemia and the risk stratification of patients with acute coronary syndromes (ACS) are of limited use mainly because they require some degree of necrosis in order to become detectable. Based on the knowledge gained into the pathophysiology of ACS, several new biomarkers have been developed. Brain natriuretic peptides (BNP and NT-proBNP) as markers of hemodynamic stress have shown in several studies a good diagnostic and prognostic performance. C-reactive protein (CRP) reflecting systemic inflammation, has mainly a role as risk stratifier. Ischemia modified albumin (IMA) a pure ischemia marker may offer a substantial aid in diagnosing an acute coronary event in patients with negative troponin. Finally, myeloperoxidase (MPO), a marker of oxidative stress, may also contribute to the diagnosis of ischemia although this is not yet supported by a fair amount of data. Nevertheless, although highly sensitive, these new biomarkers are not specific enough and a multi-marker approach seems the most appropriate strategy for diagnosis of myocardial ischemia and for assessing the risk of an adverse outcome in patients with an acute coronary syndrome.




Cardiology Update 2006