Abstract
The application of high-sensitivity cardiac troponins in clinical practice has led to an increase in the recognition of elevated concentrations in patients without myocardial ischaemia. The Fourth Universal Definition of Myocardial Infarction encourages clinicians to classify such patients as having an acute or chronic myocardial injury based on the presence or absence of a rise or a fall in cardiac troponin concentrations. Both conditions may be caused by a variety of cardiac and non-cardiac conditions, and evidence suggests that clinical outcomes are worse than patients with myocardial infarction due to atherosclerotic plaque rupture, with as few as one-third of patients alive at 5 years. Major adverse cardiovascular events are comparable between populations, and up to three-fold higher than healthy individuals. Despite this, no evidence-based strategies exist to guide clinicians in the investigation of non-ischaemic myocardial injury. This review explores the aetiology of myocardial injury and proposes a simple framework to guide clinicians in early assessment to identify those who may benefit from further investigation and treatment for those with cardiovascular disease.
Highlights
The clinical application of cardiac biomarkers for the diagnosis of myocardial infarction has evolved from the use of non-specific indicators of muscle ischaemia and breakdown, including creatine kinase myocardial band (CK-MB), myoglobin, lactate dehydrogenase (LDH) and aspartate aminotransferase (AST), to the use of cardiac troponin as the only recommended biomarker [3,7]
The clinical application of cardiac biomarkers for the diagnosis of myocardial infarction has evolved from the use of non-specific indicators of muscle ischaemia and break3 of 17 down, including creatine kinase myocardial band (CK-MB), myoglobin, lactate dehydrogenase (LDH) and aspartate aminotransferase (AST), to the use of cardiac troponin as the only recommended biomarker [3,7]
This cohort had a higher incidence of previous heart failure in the type 1 group and no difference in incidence of chronic kidney disease, diabetes and chronic obstructive in outcomes may perhaps be explained by selection, as this cohort was most male, with a much higher proportion of type two myocardial infarction and less myocardial injury
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. This new definition challenges physicians to always consider the mechanisms of injury to ensure accurate diagnosis and treatment
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