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Kardiale Biomarker in der Notfallmedizin

Cardiac biomarkers in emergency medicine

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Zusammenfassung

Die Evaluierung von Patienten mit Herzinfarktverdacht ist eine der größten Herausforderungen in der Notfallmedizin. Biochemische Marker spielen hier eine herausragende Rolle und werden häufig bereits präklinisch oder früh in der innerklinischen Notfallmedizin eingesetzt. Aktuell werden die kardialen Troponine T + I und vereinzelt natriuretische Peptide verwendet. Als kardiospezifischste Biomarker werden die kardialen Troponine in den Richtlinien eindeutig als bevorzugte Marker für die Diagnostik und Risikostratifizierung von Patienten mit akutem Koronarsyndrom angegeben. Da die Troponine als Marker myokardialen Zelluntergangs ausschließlich stattgehabte Gewebeschädigung anzeigen und erst mit Zeitverzögerung nach Symptombeginn im Blut messbar sind, besteht der Bedarf nach einer neuen Generation von Markern und Assays, die frühzeitig vor Eintritt einer irreversiblen Schädigung Risikopatienten identifizieren und einer Therapie zugänglich machen. Diese Übersichtsarbeit befasst sich mit einer Reihe neuer kardialer Biomarker, die aufgrund ihres Pathomechanismus oder ihrer Assayeigenschaften versprechen, diesen Bedarf zukünftig abzudecken und in den Klinikalltag integrierbar zu sein. Dazu gehören die hochsensitiven kardialen Troponine, Copeptin, „h-fatty acid binding protein“, Cholin, natriuretische Peptide und die lipoproteinassoziierte Phospholipase A2.

Abstract

The evaluation of patients with suspected myocardial infarction is one of the biggest challenges in emergency medicine. Biochemical markers play an important role in the evaluation process and can be applied either pre-clinically or early in clinical emergency management. Troponin T and I and to a certain extent natriuretic peptides are well known markers that are being used in routine clinical practice. The cardiac troponins I and T are the most cardio-specific and sensitive cardiac biomarkers available and current guidelines specify them as the preferred markers for the diagnosis and risk stratification in patients with acute coronary syndrome. As troponins only measure myocardial cell damage that has already occurred, levels start increasing with a time delay after symptom onset. There is an unmet need for a new generation of markers which can identify high risk patients earlier or even before irreversible tissue damage occurs to be able to allocate patients to their personalized and appropriate therapy. This review article addresses a number of new cardiac biomarkers which, due to their pathomechanism or to the characteristics of their assay, hold the promise to meet this requirement and can be integrated into routine practice. The biomarkers included are high sensitive troponins, copeptin, h-fatty acid binding protein, choline, natriuretic peptides und lipoprotein-associated phospholipase A2.

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Danksagung

Wir danken Herrn Dankward Hänlein für seine freundliche Unterstützung bei der Erstellung der Abbildung 2.

Interessenkonflikt

Die Forschungsgruppe erhält Forschungsgelder von Abbott Laboratories und B.R.A.H.M.S. GmbH.

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  1. Medizinische Kliniken mit Schwerpunkt Kardiologie und Nephrologie/Internistische Intensivmedizin, Institut für Klinische Chemie, Campus Virchow-Klinikum und Arbeitsbereich Notfallmedizin/Rettungsstellen, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    M. Möckel, J. Searle, O. Danne & C. Müller

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  1. M. Möckel
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  2. J. Searle
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  3. O. Danne
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  4. C. Müller
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Correspondence to M. Möckel.

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Möckel, M., Searle, J., Danne, O. et al. Kardiale Biomarker in der Notfallmedizin. Notfall Rettungsmed 14, 229–242 (2011). https://doi.org/10.1007/s10049-010-1350-7

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