Troponins, Myoglobin, and Fatty Acid Binding Protein (FAPB)

The importance of using cardiac markers to aid in rapid diagnosis of acute myocardial infarction (AMI) is well documented. In the Western world, heart disease is the major cause of mortality. And in the US alone, eight million people are admitted to the emergency room annually with suspected heart attacks. Diagnosis is confirmed for 1.5 million and of these approximately 500,000 die. The rapid and accurate identification of heart attack victims greatly improves chances for recovery.

As a result, the market for cardiac marker diagnostic kits, their component antibodies and antigens is substantial.

Of the key cardiac markers – including troponin-I, troponin-T, CK-MB, myoglobin and FABP – troponin-I is fast becoming the marker of first choice, based on its absolute cardiac specificity and its long serum half-life. Troponin-T has a similar profile, but is associated with a degree of non-specificity since elevated levels are found in some renal diseases and diabetes.

Until recently, CK-MB was the cardiac marker of choice. Compared to the troponins, it has a lower cardiac specificity and a relatively short serum half-life. Nonetheless, CK-MB is well established as a clinical diagnostic tool and remains a target worth pursuing.

Like CK-MB, myoglobin long been used as a cardiac marker. Its rapid increase following AMI allows for correspondingly rapid patient evaluation.
FABP, a low molecular weight protein (approx. 15,000 kD), represents a newer alternative to myoglobin that has attracted interest, particularly in Japan and Europe. Its kinetic profile is similar to that of myoglobin, but FABP has a higher cardiac specificity. Although acceptance of FABP as a viable diagnostic tool is limited at present, it is expected to increase.

Increased emphasis is now being placed on developing blood tests to detect injury to the heart muscle as early as possible among people with chest discomfort or other signs of a potentially serious heart problem. Blood tests confirm or refute suspicions raised in the early stages of evaluation that may occur in an emergency room, intensive care unit or urgent care setting. Such tests are sometimes called heart damage markers or cardiac enzymes.

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