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Cardiac Biomarkers

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Summary Tables

The following tables summarize currently used cardiac biomarkers.

Cardiac Biomarker Tests

These tests are used to help diagnose, evaluate, and monitor people suspected of having Acute Coronary Syndrome (ACS).
Markerwhat it isTissue sourceReason for IncreaseTime to IncreaseTime Back to NormalWhen/How Used
Cardiac Troponin Regulatory protein complex; two cardiac-specific isoforms: T and I Heart Injury to heart 3 to 4 hours Remains elevated for 10 to 14 days Diagnose heart attack, risk stratification, assist in deciding management, assess degree of damage

High-sensitivity cardiac troponin

Currently not approved in U.S. but may be soon; it is routinely used in Canada, Europe

Same as above, just measures the same protein at a much lower level Heart Injury to heart Within 3 hours of onset of symptoms Same as above Same as above; may also be elevated in stable angina and people without symptoms and indicates risk of future cardiac events (e.g., heart attacks)
CK Enzyme; total of three different isoenzymes Heart, brain, and skeletal muscle Injury to skeletal muscle and/or heart cells 3 to 6 hours after injury, peaks in 18 to 24 hours 48 to 72 hours, unless due to continuing injury Frequently performed in combination with CK-MB; sometimes to detect second heart attack occurring shortly after the first
CK-MB Heart-related isoenzymes of CK Heart primarily, but also in skeletal muscle Injury to heart and/or muscle cells 3 to 6 hours after heart attack, peaks in 12 to 14 hours 48 to 72 hours, unless new or continuing damage Less specific than troponin, may be ordered when troponin is not available
Myoglobin Oxygen-storing protein Heart and other muscle cells Injury to muscle and/or heart cells 2 to 3 hours after injury, peaks in 8 to 12 hours Within one day after injury Used less frequently; sometimes performed with troponin to provide early diagnosis

 

Biomarker Tests Used for Prognosis

These tests may be used to evaluate risk of future cardiac events.
bioMarkerwhat it isReason for IncreaseWhen/How Used
hs-CRP Protein Inflammation May help determine risk of future cardiac events in those patients who have had a heart attack
BNP and NT-proBNP Heart hormone Heart failure; increased risk of another heart attack Usually used to recognize heart failure, but an increased level in people with ACS indicates an increased risk of recurrent events 

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