Cardiac Markers

Cardiac Markers is a comprehensive, up-to-date summary of clinical information on serum cardiac markers for coronary artery disease. This book reviews in detail the biochemistry, clinical significance, and analytical measurements for each marker, as well as the advantages and limitations of existing and proposed markers. Comprehensive descriptions of therapeutic approaches to manage patients are presented. Also included are up-to-date listings of primary references and commercial methodologies, the latest data on the pathophysiology of unstable angina, and a discussion of the new emergency-room chest pain centers. Anyone who needs to know how to examine, diagnose, treat, and manage patients with acute chest pain and heart attacks will find this book indispensable.

For a cardiologist, reviewing Cardiac Markers, written predominantly by and for clinical biochemists, feels uncomfortably like reading someone else's diary. However, the nature of this book's subject will encourage prying eyes. The inadequacy of clinical acumen, gravitas, and a long stethoscope in diagnosing acute coronary syndromes is a disappointing fact of life, and the blood test has long been enshrined in the World Health Organization's definition of acute myocardial infarction. Recent advances in noninvasive and invasive treatments of acute coronary syndromes depend on early and rapid diagnosis. For this reason, considerable energy and resources have been channeled into the quest for the "perfect" test of myocardial injury. The numerous markers that have emerged from this frenetic research, as well as the incorporation of these markers into new prognostic and therapeutic algorithms, has meant that the need to understand this rapidly evolving field is not confined to the clinical laboratory. This book will therefore appeal to a wider readership than its intended audience.

The book is simple in layout. The first of four sections consists primarily of an overview of acute coronary syndromes and their management and ends with a chapter on the ultrastructure of the striated-muscle cell. The second and third sections deal with cardiac markers of the past, present, and future, beginning with cytosolic enzymes and ending with sarcomeric proteins. The final section addresses the future clinical role of cardiac markers, with an entire chapter devoted to the regulation and feasibility of point-of-care testing. Most of the chapters are concise and well illustrated. Particularly informative are the chapters on troponins and creatine kinase, arguably the most important of the markers discussed. These chapters are written and illustrated in such a way that the methods and limitations of the assays can be readily appreciated by biochemists and clinicians alike. One interesting concept that emerges from these chapters is the potential application of cardiac markers beyond the diagnosis of acute coronary syndromes: from the stratification of risk in cardiac failure to the diagnosis of cardiac-transplant rejection. As the sensitivity and specificity increase, the detection of inflammatory damage to myocytes is likely to have an effect on the diagnosis and management of these and related conditions, including cardiomyopathies.

One of the casualties of the information age is the coherent, single-author medical book. Despite its relatively narrow subject, this book boasts no fewer than 15 contributors, with a consequent lack of uniformity in style and presentation and some overlap among chapters. The final chapter includes brief sections on C-reactive protein in atheroma and on functional imaging in the diagnosis of coronary disease. These discussions seem out of place. The lack of a concluding overview of the markers discussed earlier in the book and their probable future role in the clinical arena contributes to a slightly disjointed quality of the book, although a brief overview can be found in the editor's preface.

These cosmetic comments notwithstanding, this short book addresses the need in a variety of disciplines for an understanding of the evolving role of cardiac markers, particularly in relation to the diagnosis and treatment of acute coronary syndromes. The book provides a concise and informative summary of a rapidly developing field and will be a useful addition to the bookshelves of clinical pathologists, emergency physicians, and cardiologists.

Reviewed by Niall G. Mahon, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.