Biochemische Diagnosesicherung und Risikostratifizierung des akuten Koronarsyndroms unter besonderer Berücksichtigung der kardialen Troponine
Three studies with respect to the biochemical evaluation of acute coronary syndromes were undertaken : (1) The clinical application of biochemical markers for diagnosis and risk stratification in patients with acute coronary syndroms. (2) The value of cardiac troponins under different physiological and pathophysiological conditions. (3) Experimental transient myocardial ischemia in an animal model with respect to the question, whether elevation of cardiac troponins in plasma perhaps occur after reversible myocardial damage. The clinical appilication of cardiac markers is sufficiently possible following actual guidelines and should include cardiac troponin measurement. The troponin test-system has to be evaluated in clinical studies with respect to its diagnostic and prognostic properties. In this study significant differences between two cardiac troponin I test-systems could be shown. The differences were below clinical relevance. Mild to moderate elevations of cardiac troponin T in patients with acute coronary syndromes and low grade Braunwald class angina are of prognostic value and add on information obtained by history and ECG. Cardiac troponins may be found elevated in apparently healthy athletes after exhaustive exercise. The prognostic significance of these findings remains unclear. Cardiac troponins are frequently elevated in renal insufficiency patients without cardiac symptoms. These elevations had no prognostic value in our study. The experimental data suggest that troponins are released in reversible myocardial damage during transient ischemia. This adds evidence on the continuous release hypothesis of cardiac troponins and degradation products. The future development of guidelines for the use of cardiac markers in daily routine will strictly depend on therapeutic consequences which base on the analytical results in the sense of evidence based medicine.
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School:Humboldt-Universität zu Berlin
Source Type:Master's Thesis
Keywords:Kardiales Troponin I und T Cardiac troponin and acute coronary syndrome renal insufficiency exercise
Date of Publication:11/29/2001