Skip to main content
Article thumbnail
Location of Repository

Bench-to-bedside review: The value of cardiac biomarkers in the intensive care patient

By Anthony S McLean, Stephen J Huang and Mark Salter


The use of cardiac biomarkers in the intensive care setting is gaining increasing popularity. There are several reasons for this increase: there is now the facility for point-of-care biomarker measurement providing a rapid diagnosis; biomarkers can be used as prognostic tools; biomarkers can be used to guide therapy; and, compared with other methods such as echocardiography, the assays are easier and much more affordable. Two important characteristics of the ideal biomarker are disease specificity and a linear relationship between the serum concentration and disease severity. These characteristics are not present, however, in the majority of biomarkers for cardiac dysfunction currently available. Those clinically useful cardiac biomarkers, which naturally received the most attention, such as troponins and B-type natriuretic peptide, are not as specific as was originally thought. In the intensive care setting, it is important for the user to understand the degree of specificity of these biomarkers and that the interpretation of the results should always be guided by other clinical information. The present review summarizes the available biomarkers for different cardiac conditions. Potential biomarkers under evaluation are also briefly discussed

Topics: Review
Publisher: BioMed Central
OAI identifier:
Provided by: PubMed Central
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://www.pubmedcentral.nih.g... (external link)
  • Suggested articles


    1. (1993). A: Mechanism and significance of myocardial uptake of antimyosin antibody in myocarditis and cardiomyopathy: clinical and experimental studies. Clin Immunol Immunopathol
    2. (1996). A: Plasma protein acute-phase response in unstable angina is not induced by ischemic injury. Circulation
    3. (2002). Acute coronary syndrome: biochemical strategies in the troponin era. Chest
    4. (2005). Almog Y: The role of cardiac troponin I as a prognosticator in critically ill medical patients: a prospective observational cohort study. Crit Care
    5. (2006). Apple FS: Biomarkers in acute cardiac disease: the present and the future.
    6. (2002). AS: B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation
    7. (2008). AS: The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testing. Am Heart J
    8. (2005). Babalis DK: The significance of CA125 levels in patients with chronic congestive heart failure. Correlation with clinical and echocardiographic parameters.
    9. (2003). Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study.
    10. (2005). Bellissant E, Cavaillon JM: Septic shock. Lancet
    11. (2004). Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J
    12. (2003). C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest
    13. (2004). C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intensive Care Med
    14. (1989). C-reactive protein: the best laboratory indicator available for monitoring disease activity.
    15. (2006). Cardiac troponin I and ventricular arrhythmia in patients with chronic heart failure.
    16. (1999). CG: Reduction in the cobalt binding capacity of human albumin with myocardial ischemia [abstract]. Ann Emerg Med
    17. (1998). Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I. American Association for Clinical Chemistry Subcommittee on cTnI Standardization. Clin Chem
    18. (2004). Chiche JD: Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med
    19. (2007). Coats AJ: The epidemiology of heart failure in Australia.
    20. (1999). de Leeuw PW: Effects of brain natriuretic peptide on forearm vasculature: comparison with atrial natriuretic peptide. Cardiovasc Res
    21. (2005). de Leeuw PW: Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacology. Fundam Clin Pharmacol
    22. (2007). de Lemos JA: Interleukin-18, the metabolic syndrome, and subclinical atherosclerosis: results from the Dallas Heart Study. Arterioscler Thromb Vasc Biol
    23. (2003). DE: The confounding effects of age, gender, serum creatinine, and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients. Crit Care Med
    24. (2003). Dei Cas L: Serum levels of carbohydrate antigen 125 in patients with chronic heart failure: relation to clinical severity, hemodynamic and Doppler echocardiographic abnormalities, and short-term prognosis.
    25. (2001). Dinarello CA: Inhibition of caspase 1 reduces human myocardial ischemic dysfunction via inhibition of IL-18 and IL-1β β. Proc Natl Acad Sci USA
    26. (2006). Eby CS: Ischemia-modified albumin increases after skeletal muscle ischemia during arthroscopic knee surgery.
    27. (2001). Elevation of troponin I in sepsis and septic shock. Intensive Care Med
    28. (2001). ET: Modulation of Creactive protein-mediated monocyte chemoattractant protein1 induction in human endothelial cells by anti-atherosclerosis drugs. Circulation
    29. (2000). Expression of angiotensin II and interleukin 6 in human coronary atherosclerotic plaques: potential implications for inflammation and plaque instability. Circulation
    30. (1985). Fatty acid binding proteins from heart. Chem Phys Lipids
    31. (2003). Fehr T: Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes.
    32. (2004). Francis L: Elevation of the tumor marker CA125 in right heart failure. South Med J
    33. (2003). Garlichs CD: Enhanced levels of CD154 (CD40 ligand) on platelets in patients with chronic heart failure.
    34. (2005). GC: High-workload endurance training may increase serum ischemia-modified albumin concentrations. Clin Chem Lab Med
    35. (1997). GC: Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet
    36. (1998). Ghezzi P: Corticosteroid-independent inhibition of tumor necrosis factor production by the neuropeptide urocortin.
    37. (2002). Giannitsis E, Katus HA: Cardiac troponin elevations in patients without acute coronary syndrome. Circulation
    38. (2006). Goncalves FR: Troponin I as a marker of right ventricular dysfunction and severity of pulmonary embolism. Rev Port Cardiol
    39. (2000). Gorus FK: Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock. Clin Chem
    40. (2005). GS: B-type natriuretic peptide and the prediction of outcome in patients admitted to intensive care. Anaesthesia
    41. (2001). Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J
    42. (2000). Hennekens CH: Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation
    43. (1998). HJ: Biochemical detection of left-ventricular systolic dysfunction. Lancet
    44. (2002). HJ: Interleukin-18 is a strong predictor of cardiovascular death in stable and unstable angina. Circulation
    45. (2006). Huang SJ: Intensive care echocardiography. In
    46. (2005). Huang SJ: The applications of B-type natriuretic peptide measurement in the intensive care unit. Curr Opin Crit Care
    47. (2005). Huang SJ: The effects of acute fluid loading on plasma B-type natriuretic peptide levels in a septic shock patient. Anaesth Intensive Care
    48. (2007). I: Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients.
    49. (2003). Increased B-type natriuretic peptide (BNP) level is a strong predictor for cardiac dysfunction in intensive care unit patients. Anaesth Intensive Care
    50. (2002). Inflammation in atherosclerosis.
    51. (2005). Inflammation, atherosclerosis, and coronary artery disease.
    52. (2006). Ischemia-modified albumin concentrations should be interpreted with caution in patients with low serum albumin concentrations. Med Princ Pract
    53. (2006). JA: Prevalence and determinants of troponin T elevation in the general population. Circulation
    54. (1999). JA: Troponin I and myocardial injury in the ICU.
    55. (1995). Jaffe AS: Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA
    56. (2004). JC: Role of ‘ischemia modified albumin’, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J
    57. (2004). JE: Plasma urocortin in human systolic heart failure. Clin Sci (Lond)
    58. (2000). JP: Myocardial infarction redefined – a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.
    59. (2004). JR: Cardiac troponins and renal disease. Nephrology
    60. (2000). JV: A novel assay for cobalt–albumin binding and its potential as a marker for myocardial ischemiaa preliminary report.
    61. (2000). Kangawa K: Urocortin, a member of the corticotropin-releasing factor family, in normal and diseased heart.
    62. (2000). Katus H: It’s time for a change to a troponin standard. Circulation
    63. (1983). Knapp RC: A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer.
    64. (2007). Lam CW: Elevation of pro-inflammatory cytokines, C-reactive protein and cardiac troponin T in chronic renal failure patients on dialysis. Immunol Invest
    65. (2005). Lewandrowski KB: The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study.
    66. (2007). Montalescot G: Pre-hospital detection of acute myocardial infarction with ultra-rapid human fatty acid-binding protein (H-FABP) immunoassay.
    67. (2002). MS: Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction.
    68. (2005). Multiple plaque rupture and C-reactive protein in acute myocardial infarction.
    69. (2007). MW: The combination of B-type natriuretic peptide and C-reactive protein provides incremental prognostic value among older patients referred for cardiac catheterization.
    70. (2005). N-terminal pro-brain natriuretic peptide as an indicator of right ventricular dysfunction.
    71. (2007). Ngako A: Heart-type fatty acid-binding proteins (HFABP): a reliable tool for initial risk stratification of pulmonary embolism? Eur Heart J
    72. (2005). NH: Circulating markers of inflammation are related to carotid artery atherosclerosis. Int Angiol
    73. (2000). P: CD154 (CD40 ligand).
    74. (1984). Parrillo JE: Profound but reversible myocardial depression in patients with septic shock. Ann Int Med
    75. (1986). Parrillo JE: The coronary circulation in human septic shock. Circulation
    76. (2006). PJ: Elevated cardiac troponin levels in critically ill patients: prevalence, incidence, and outcomes.
    77. (2005). PJ: Elevated troponin and myocardial infarction in the intensive care unit: a prospective study. Crit Care
    78. (2006). Pollack CV: Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J
    79. (2004). PR: Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock.
    80. (2004). Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of Btype natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath.
    81. (2003). Prognostic implications of elevated whole blood choline levels in acute coronary syndromes.
    82. (2007). Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure.
    83. (2007). Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation
    84. (1999). Rodiger W: CA 125 and its relation to cardiac function. Am Heart J
    85. (2006). Sabatine MS: Prognostic utility of heart-type fatty acid binding protein in patients with acute coronary syndromes. Circulation
    86. (2005). Sabino H: C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect
    87. (2003). Schonbeck U: Soluble CD40L: risk prediction after acute coronary syndromes. Circulation
    88. (2007). Seppelt I: Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med
    89. (1991). Serum and urinary human heart fatty acid-binding protein in acute myocardial infarction. Clin Biochem
    90. (2001). Siegbahn A: Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy. JAMA
    91. (1995). Simmons MD: Measurement of serum troponin T, creatine kinase MB isoenzyme, and total creatine kinase following arduous physical training. Ann Clin Biochem
    92. (2006). SL: Plasma myeloperoxidase levels in patients with chronic heart failure.
    93. (2003). SL: Prognostic value of myeloperoxidase in patients with chest pain.
    94. (2004). T: Biochemical markers of myocyte injury in heart failure. Heart
    95. (2007). T: Cardiac troponin T vs other biochemical markers in patients with congestive heart failure. Circ J
    96. (2004). Tedgui A: Evidence for altered interleukin 18 (IL)-18 pathway in human heart failure.
    97. (2001). Tedgui A: Expression of interleukin-18 in human atherosclerotic plaques and relation to plaque instability. Circulation
    98. (2004). Tomlanovich MC: Prevalence of elevated troponin I in end-stage renal disease patients receiving hemodialysis. Acad Emerg Med
    99. (2003). Torbicki A: N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism. Eur Respir J
    100. (2006). Touyz RM: Increased systemic inflammation and oxidative stress in patients with worsening congestive heart failure: improvement after short-term inotropic support. Clin Sci (Lond)
    101. (2006). Tschoke S: Serial analysis of troponin I levels in patients with ischemic and nonischemic dilated cardiomyopathy. Clin Cardiol
    102. (1993). Usefulness of serum CA125 measurement for monitoring pericardial effusion. Jpn Circ J
    103. (2004). Wall stress modulates brain natriuretic peptide production in pressure overload cardiomyopathy.
    104. (2000). Wallentin L: Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease.
    105. (1972). WE: Serum enzyme determinations in the diagnosis and assessment of myocardial infarction. Circulation
    106. (2003). Werdan K: Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsisassociated left ventricular dysfunction. Intensive Care Med
    107. (2007). Whole blood choline and plasma choline in acute coronary syndromes: prognostic and pathophysiological implications. Clin Chim Acta
    108. (1966). Willebrands AF: Isoenzymes of creatine phosphokinase in tissue extracts and in normal and pathological sera. Clin Chim Acta
    109. (2002). WW: Beneficial hemodynamic, endocrine, and renal effects of urocortin in experimental heart failure: comparison with normal sheep.

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.