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En la actualidad, las enfermedades cardiovasculares se consideran la pandemia más significativa del siglo XXI. Dentro de ellas, la enfermedad coronaria es la más prevalente y la que más morbi-mortalidad genera; en el caso particular de Colombia, es la principal causa de muerte en individuos mayores de 45 años. La característica silenciosa de esta enfermedad ha impulsado la investigación de moléculas que permitan su diagnóstico precoz y sirvan como predictores pronóstico tanto en la fase crónica como en la aguda.
Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.
Palabras clave:
biomarcadores
cardiopatía isquémica
inflamación
infarto agudo del miocardio
Cardiovascular diseases are currently considered the most significant pandemic of the XXI century. Among them, coronary disease is the most prevalent and the one that generates more morbidity and mortality. In Colombia, is the main cause of death in individuals over 45 years. The silent characteristics of this disease has promoted research of molecules that allow early diagnosis and serve as predictors of prognosis both in chronic and acute phases.
As result of this research, there has been significant progress in the development of cardiac biomarkers in the last thirty years. Among them are the newly developed ultrasensitive troponin assays for an early diagnosis, measurement of ischemia modified albumin, which has high negative predictive value for the detection of myocardial ischemia, soluble CD40 ligand for classification and individualization of treatment, the usefulness of CRP as a risk marker for coronary heart disease and various high-throughput techniques such as proteomics, which allow the detection of multiple potential biomarkers. Despite this, there is still insufficient evidence for replacing the markers recommended by the scientific associations by new developed markers, and the debate about what combination to use in order to achieve higher performance diagnosis, prognosis and therapy, continues Here we review current advances in cardiac biomarkers and their potential integration into daily clinical practice.
Keywords:
biomarkers
ischemic heart disease
inflammation
acute myocardial infarction
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