Am J Cardiovasc Dis 2013;3(2):60-70
Original Article
Increase in cardiac myosin binding protein-C plasma levels is a sensitive
and cardiac-specific biomarker of myocardial infarction
Suresh Govindan, Diederik WD Kuster, Brian Lin, Daniel J Kahn, Walter P Jeske, Jeanine M Walenga, Fred Leya, Debra
Hoppens-teadt, Jawed Fareed, Sakthivel Sadayappan
Department of Cell and Molecular Physiology, Departments of Pathology, Thoracic and Cardiovascular Surgery,
Interventional Cardiology, Pharmacology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
Received March 8, 2013; Accepted April 20, 2013; Epub June 10, 2013; Published June 15, 2013
Abstract: Earlier studies have shown that cardiac myosin binding protein-C (cMyBP-C) is easily releasable into the
circulation following myo-cardial infarction (MI) in animal models and patients. However, since its release kinetics has not
been clearly demonstrated, no parameters are available to judge its efficacy as a bona fide biomarker of MI in patients with
MI. To make this assessment, plasma levels of cMyBP-C and six known biomarkers of MI were determined by sandwich
enzyme-linked immunosorbent assay in patients with MI who had before and after Percutaneous Transcoronary
Angioplasty (PTCA), as well as healthy controls. Compared to healthy controls (22.3 ± 2.4 ng/mL (n=54)), plasma levels of
cMyBP-C were significantly increased in patients with MI (105.1 ± 8.8 ng/mL (n=65), P<0.001). Out of 65 patients, 24 had
very high levels of plasma cMyBP-C (116.5 ± 13.3 ng/mL), indicating high probability of MI. Importantly, cMyBP-C levels were
significantly decreased in patients (n=40) at 12 hours post-PTCA (41.2 ± 9.3 ng/mL, P<0.001), compared to the patients
with MI. Receiver operating characteristic analysis revealed that a plasma cMyBP-C reading of 68.1 ng/mL provided a
sensitivity of 66.2% and a specificity of 100%. Also, myoglobin, carbonic anhydrase and creatine kinase-MB levels were
significantly increased in MI patients who also had higher cMyBP-C levels. In contrast, levels of cardiac troponin I, glycogen
phosphorylase and heart-type fatty acid binding protein were not significantly changed in the samples, indicating the
importance of evaluating the differences in release kinetics of these biomarkers in the context of accurate diagnosis. Our
findings suggest that circulating cMyBP-C is a sensitive and cardiac-specific biomarker with potential utility for the accurate
diagnosis of MI. (AJCD1303002).
Keywords: Acute coronary syndrome, cardiac biomarker, cardiac myosin binding protein-C, contractile protein, cMyBP-C,
myocardial infarction
Address correspondence to: Dr. Sakthivel Sadayappan, Department of Cell and Molecular Physiology, Stritch School of
Medicine, Loyola Uni-versity Chicago, 2160 South First Ave., Maywood, IL 60153, USA. Phone: 708-216-7994; Fax:
708-216-6308; E-mail: ssadayappan@lumc.edu
Original Article
Increase in cardiac myosin binding protein-C plasma levels is a sensitive
and cardiac-specific biomarker of myocardial infarction
Suresh Govindan, Diederik WD Kuster, Brian Lin, Daniel J Kahn, Walter P Jeske, Jeanine M Walenga, Fred Leya, Debra
Hoppens-teadt, Jawed Fareed, Sakthivel Sadayappan
Department of Cell and Molecular Physiology, Departments of Pathology, Thoracic and Cardiovascular Surgery,
Interventional Cardiology, Pharmacology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
Received March 8, 2013; Accepted April 20, 2013; Epub June 10, 2013; Published June 15, 2013
Abstract: Earlier studies have shown that cardiac myosin binding protein-C (cMyBP-C) is easily releasable into the
circulation following myo-cardial infarction (MI) in animal models and patients. However, since its release kinetics has not
been clearly demonstrated, no parameters are available to judge its efficacy as a bona fide biomarker of MI in patients with
MI. To make this assessment, plasma levels of cMyBP-C and six known biomarkers of MI were determined by sandwich
enzyme-linked immunosorbent assay in patients with MI who had before and after Percutaneous Transcoronary
Angioplasty (PTCA), as well as healthy controls. Compared to healthy controls (22.3 ± 2.4 ng/mL (n=54)), plasma levels of
cMyBP-C were significantly increased in patients with MI (105.1 ± 8.8 ng/mL (n=65), P<0.001). Out of 65 patients, 24 had
very high levels of plasma cMyBP-C (116.5 ± 13.3 ng/mL), indicating high probability of MI. Importantly, cMyBP-C levels were
significantly decreased in patients (n=40) at 12 hours post-PTCA (41.2 ± 9.3 ng/mL, P<0.001), compared to the patients
with MI. Receiver operating characteristic analysis revealed that a plasma cMyBP-C reading of 68.1 ng/mL provided a
sensitivity of 66.2% and a specificity of 100%. Also, myoglobin, carbonic anhydrase and creatine kinase-MB levels were
significantly increased in MI patients who also had higher cMyBP-C levels. In contrast, levels of cardiac troponin I, glycogen
phosphorylase and heart-type fatty acid binding protein were not significantly changed in the samples, indicating the
importance of evaluating the differences in release kinetics of these biomarkers in the context of accurate diagnosis. Our
findings suggest that circulating cMyBP-C is a sensitive and cardiac-specific biomarker with potential utility for the accurate
diagnosis of MI. (AJCD1303002).
Keywords: Acute coronary syndrome, cardiac biomarker, cardiac myosin binding protein-C, contractile protein, cMyBP-C,
myocardial infarction
Address correspondence to: Dr. Sakthivel Sadayappan, Department of Cell and Molecular Physiology, Stritch School of
Medicine, Loyola Uni-versity Chicago, 2160 South First Ave., Maywood, IL 60153, USA. Phone: 708-216-7994; Fax:
708-216-6308; E-mail: ssadayappan@lumc.edu
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