Örebro Studies in Medicine 142 I
ÖREBRO 2016 2016AN
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anna nordenskjöld was born in Örebro in 1977. After completing medical school in Uppsala (2001) and an intern-ship, she began working in the Department of Cardiology, Örebro University Hospital. She has specialist qualifica-tion in Internal Medicine (2010) and in Cardiology (2013). In 2009, she commenced her postgraduate studies at the School of Health and Medical Sciences, Örebro University. Her research investigates the prevalence and importance of clinically unrecognized myocardial infarctions as well as the individual variation of cardiac biochemical markers in patients with stable coronary artery disease.
Ischemic heart disease, and especially one of its manifestations, myocardial infarc-tion (MI), is a major cause of morbidity and mortality worldwide. The diagnosis of acute MI is based on the combination of a change in biochemical markers of myocardial injury (currently, cardiac troponins) and typical symptoms and/ or ECG findings typical of myocardial ischemia. Occasionally the MI results in lasting ECG-changes, such as pathological Q-waves, that can be an indication of a previously experienced MI.
Despite the test available, the interpretation of results is not always straight-forward, and the diagnosis is not always correct. Many MIs are missed, maybe due to the absence of distinct symptoms and/or misinterpretation of the ECG or measures of biochemical markers. Unrecognized myocardial infarctions (UMI) are common.
Recently, more sensitive methods for detection of myocardial injury have been developed including late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and high-sensitivity assays for cardiac troponins. LGE-CMR has proven to be more sensitive for the detection of UMI than is ECG. However, little information is available regarding the clinical importance and prognostic implications of LGE-CMR-detected UMI.
The high-sensitivity assays for cardiac troponins have made it possible to reliably detect very low levels of troponins in most healthy individuals and thus quantitatively small troponin elevation in cardiac patients. With the new techni-ques it is essential to be able to discriminate low levels of cardiac troponins of clinical relevance from those that reflect biological or individual variations.
The aim of this thesis was to explore the occurrence and clinical importance of two manifestations of myocardial injury, UMI and altered levels of cardiac biochemical markers in patients with stable coronary artery disease.
issn 1652-4063 isbn 978-91-7529-125-3
