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özcan K, Ekmekçi A, Güngör B, şener S, Osmonov D, Altay S, Aruğraslan E, çinar T, Sayar N, Orhan A, Eren M. Clinical use of Serial Mean Platelet Volume Measurement for Diagnosis of Non-ST Segment Elevation Myocardial Infarction in Patients Visiting Emergency Department with Acute Chest Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We aim to demonstrate diagnostic accuracy of serial MPV measuring and to assess its correlation with cardiac troponin I (cTnI) levels. Design Cross-sectional study. Methods Consecutive patients presenting to emergency department with new onset chest pain started in the last four hours without electrocardiographic ST segment and T wave changes, pathological q waves were included in study. Complete blood count and cTnI levels were studied on admission and six hours after presentation. Patients with cTnI levels higher than 0.06 ng/ml were diagnosed as non-ST elevation myocardial infarction (NSTEMI) and other patients were matched as the control group. Results NSTEMI group had significantly higher levels of MPV on admission and at the sixth hour. The increase in MPV was corraleted with elevation of cTnI levels. At six hours follow up, the increase in MPV levels predicted myocardial ischaemia (corrected r2=0.36; p=0.001) in linear regression analysis. The corresponding area under the receiver operating characteristic curve (ROC) for admission MPV, sixth hour MPV and increase in MPV levels in predicting myocardial ischaemia in patients with increased cTnI were 0.652, 0.727 and 0.896 respectively. If MPV threshold was selected as ≥0.10 fL during follow up, myocardial ischaemia was predicted with a sensitivity of 75% and specificity of 88%. Conclusions Elevation of MPV levels in patients with acute chest pain may be an indicator of myocardial ischaemia. Serial MPV measurement can be used to complement serial cTnI measurements to diagnose NSTEMI.
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Affiliation(s)
- Ks özcan
- Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - A Ekmekçi
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - B Güngör
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - S şener
- Acibadem University Faculty of Medicine, Department of Emergency Medicine, Istanbul, Turkey
| | - D Osmonov
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - S Altay
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - E Aruğraslan
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - T çinar
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - N Sayar
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Al Orhan
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - M Eren
- Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Eggers KM, Lindahl B. Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome. Clin Chem 2017; 63:223-235. [DOI: 10.1373/clinchem.2016.261495] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/18/2016] [Indexed: 12/13/2022]
Abstract
Abstract
BACKGROUND
Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. In this review, we have summarized the data from studies investigating the implications of cardiac troponin concentrations in various acute and chronic conditions beyond ACS, i.e., heart failure, myocarditis, Takotsubo cardiomyopathy, aortic dissection, supraventricular arrhythmias, valve disease, pulmonary arterial hypertension, stroke, and in the perioperative setting.
CONTENT
Cardiac troponin concentrations are often detectable and frankly increased in non-ACS conditions, in particular when measured with high-sensitivity (hs) assays. With the exception of myocarditis and Takotsubo cardiomyopathy, cardiac troponin concentrations carry strong prognostic information, mainly with respect to mortality, or incipient and/or worsening heart failure. Studies investigating the prognostic benefit associated with cardiac troponin–guided treatments however, are almost lacking and the potential role of cardiac troponin in the management of non-ACS conditions is not defined.
SUMMARY
Increased cardiac troponin indicates increased risk for adverse outcome in patients with various cardiovascular conditions beyond ACS. Routine measurement of cardiac troponin concentrations can however, not be generally recommended unless there is a suspicion of ACS. Nonetheless, any finding of an increased cardiac troponin concentration in a patient without ACS should at least prompt the search for possible underlying conditions and these should be managed meticulously according to current guidelines to improve outcome.
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Affiliation(s)
| | - Bertil Lindahl
- Department of Medical Sciences and
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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3
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Zhang Q, Prabhu A, San A, Al-Sharab JF, Levon K. A polyaniline based ultrasensitive potentiometric immunosensor for cardiac troponin complex detection. Biosens Bioelectron 2015; 72:100-6. [DOI: 10.1016/j.bios.2015.04.084] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/15/2015] [Accepted: 04/25/2015] [Indexed: 12/11/2022]
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Collinson PO, Garrison L, Christenson RH. Cardiac biomarkers - A short biography. Clin Biochem 2014; 48:197-200. [PMID: 25464015 DOI: 10.1016/j.clinbiochem.2014.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 01/24/2023]
Affiliation(s)
- Paul O Collinson
- Department of Clinical Blood Sciences, St George's Hospital and Medical School, London, UK; Department of Cardiology, St George's Hospital and Medical School, London, UK; University of Maryland School of Medicine, Baltimore, MD 21085, USA.
| | - Lisa Garrison
- Department of Clinical Blood Sciences, St George's Hospital and Medical School, London, UK; Department of Cardiology, St George's Hospital and Medical School, London, UK; University of Maryland School of Medicine, Baltimore, MD 21085, USA
| | - Robert H Christenson
- Department of Clinical Blood Sciences, St George's Hospital and Medical School, London, UK; Department of Cardiology, St George's Hospital and Medical School, London, UK; University of Maryland School of Medicine, Baltimore, MD 21085, USA
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Aslan K. Rapid and Sensitive Detection of Troponin I-T-C Complex from Human Serum using Microwave-Accelerated Metal-Enhanced Fluorescence. ACTA ACUST UNITED AC 2011; 3:179-183. [PMID: 22163074 DOI: 10.5101/nbe.v3i3.p179-183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the rapid and sensitive detection of Troponin I-T-C (Tn I-T-C) complex from buffer and human serum samples using Microwave-Accelerated and Metal-Enhanced Fluorescence (MA-MEF) technique, which is based on the combined use of low power microwave heating, silver nanoparticle films (SNFs) and fluorescence spectroscopy. The detection of Tn I-T-C complex from buffer solutions and human serum samples on SNFs was carried out using fluorescence-based immunoassays at room temperature (control immunoassay, 2 hour total assay time) and using low-power microwave heating (MA-MEF-based immunoassay, 1 minute total assay time). A lower detection limit for Tn I-T-C complex from buffer solutions in the control immunoassay and MA-MEF-based immunoassay was 0.01 ng/ml and 0.005 ng/ml, respectively. However, the lower detection limit for Tn I-T-C complex from human serum in the control immunoassay was increased to 10 ng/ml. The use of MA-MEF technique afforded for the detection of Tn I-T-C complex from human serum samples in 1 min with a lower detection limit of 0.05 ng/ml.
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Affiliation(s)
- Kadir Aslan
- Morgan State University, Department of Chemistry, 1700 East Cold Spring Lane, Baltimore, MD 21251
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Aslan K, Grell TAJ. Rapid and sensitive detection of troponin I in human whole blood samples by using silver nanoparticle films and microwave heating. Clin Chem 2011; 57:746-52. [PMID: 21398602 DOI: 10.1373/clinchem.2010.159889] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiovascular diseases are among the leading causes of mortality in developed countries. It is widely recognized that troponin I (TnI) can be used for the assessment of a myocardial infarction. METHODS We investigated the use of the microwave-accelerated and metal-enhanced fluorescence (MA-MEF), a technique based on the combined use of low-power microwave heating, silver nanoparticle films (SNFs), and fluorescence spectroscopy for the detection of TnI from human whole blood samples. SNFs were deposited onto amine-modified glass microscope slides by use of Tollen's reaction scheme and characterized by optical absorption spectroscopy and scanning electron microscopy. The detection of TnI from buffer solutions and human whole blood samples on SNFs was carried out by using fluorescence-based immunoassays at room temperature (control immunoassay, 2 h total assay time) or microwave heating (MA-MEF-based immunoassay, 1 min total assay time). RESULTS We found that the lower limits of detection for TnI from buffer solutions in the control immunoassay and MA-MEF-based immunoassay were 0.1 μg/L and 0.005 μg/L, respectively. However, we were unable to detect TnI in whole blood samples in the control immunoassays owing to the coagulation of whole blood within 5 min of the incubation step. The use of the MA-MEF technique allowed detection of TnI from whole blood samples in 1 min with a lower detection limit of 0.05 μg/L. CONCLUSIONS The MA-MEF-based immunoassay is one of the fastest reported quantitative detection methodos for detection of TnI in human whole blood and has low detection limits similar to those obtained with commercially available immunoassays.
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Affiliation(s)
- Kadir Aslan
- Department of Chemistry, Morgan State University, Baltimore, MD, USA.
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7
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Clinical performance of a new point-of-care cardiac troponin I assay compared to three laboratory troponin assays. Clin Chim Acta 2011; 412:370-5. [DOI: 10.1016/j.cca.2010.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 11/10/2010] [Accepted: 11/10/2010] [Indexed: 11/21/2022]
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8
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Collinson PO. Acute coronary syndromes: Troponin triumphant? Nat Rev Cardiol 2009; 6:740-1. [PMID: 19935682 DOI: 10.1038/nrcardio.2009.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lippi G, Filippozzi L, Salvagno GL, Montagnana M, Franchini M, Guidi GC, Targher G. Increased mean platelet volume in patients with acute coronary syndromes. Arch Pathol Lab Med 2009; 133:1441-3. [PMID: 19722752 DOI: 10.5858/133.9.1441] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Despite remarkable progress, the diagnosis of acute coronary syndromes (ACS) is still challenging. OBJECTIVE The mean platelet volume (MPV), a simple and reliable indicator of platelet size that correlates with platelet activation, might be an emerging cardiovascular risk marker and potentially helpful in stratifying cardiovascular risk. DESIGN We analyzed MPV values in 2304 adult patients who were consecutively admitted during a 1-year period to the emergency department of the University Hospital of Verona for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine hematologic testing, whereas cardiac troponin T measurements were collected both at baseline and after 4, 6, and 12 hours. RESULTS A total of 456 patients (19.8% of total) had ACS. These patients, all having cardiac troponin T levels of 0.03 ng/mL or greater in addition to ischemic electrocardiographic changes, had higher MPV values than non-ACS patients with normal cardiac troponin T levels (median, 8.0 fL [5th to 95th percentiles, 6.7-10.0 fL] versus median, 7.4 fL [5th to 95th percentiles, 6.5-9.5 fL]; P < .001). The diagnostic accuracy of MPV, calculated as the area under the curve by the receiver operating characteristic analysis, was 0.661 (P < .001). At the 9.0-fL cutoff, the negative and positive predictive values of MPV were 83% and 43%, respectively. CONCLUSIONS Because MPV is a simple and inexpensive laboratory measurement, it might be considered a useful rule-out test along with other conventional cardiac biomarkers for the risk stratification of ACS patients admitted to the emergency departments.
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Affiliation(s)
- Giuseppe Lippi
- Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy.
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10
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Lippi G, Filippozzi L, Montagnana M, Salvagno GL, Franchini M, Guidi GC, Targher G. Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes. Clin Chem Lab Med 2009; 47:353-7. [PMID: 19676148 DOI: 10.1515/cclm.2009.066] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Conventional cardiac markers used for the biochemical diagnosis of acute coronary syndromes (ACS) have a high specificity but low sensitivity within 2-4 h of symptoms onset. The red blood cell distribution width (RDW), reflecting the size variability of circulating red blood cells, has been shown to be independently associated with an increased risk of major cardiovascular events. We assessed whether there is an association between RDW at admission and cardiac troponin T (cTnT) elevation in patients with chest pain. METHODS We analyzed RDW values in 2304 adult patients, who were consecutively admitted over a 1-year period to the local emergency department for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine haematological testing, whereas cTnT was measured at baseline and after 4, 6, and 12 h. RESULTS A total of 456 patients (19.8% of total) had ACS. These patients, all having cTnT> or =0.03 microg/L up to 12 h from admission other than ischaemic electrocardiographic changes, had higher RDW than non-ACS patients [median 15.1%, (5th-95th percentiles) 13.2%-19.0% vs. 13.5%, 12.9%-17.1%, p<0.001]. On admission, the sensitivity and specificity of cTnT were 94% (25 false negative results) and 100%, respectively. The diagnostic accuracy of RDW, as calculated by the receiver operating characteristic curve analysis, was 0.705 (p<0.001). At the cut-off value of 14%, the clinical sensitivity and specificity of RDW on admission were 79% and 50%, respectively. In 21 out of 25 patients classified as false negative for cTnT on admission, the RDW was >14%. Accordingly, the diagnostic sensitivity of the two combined measurements on admission was 99%. CONCLUSIONS As RDW is widely available to clinicians as a part of the complete blood count, and therefore incurs no additional costs, it might be considered with other conventional cardiac markers for the risk stratification of ACS patients admitted to emergency departments.
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Affiliation(s)
- Giuseppe Lippi
- Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy.
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11
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Kelley WE, Lockwood CM, Cervelli DR, Sterner J, Scott MG, Duh SH, Christenson RH. Cardiovascular disease testing on the Dimension Vista system: biomarkers of acute coronary syndromes. Clin Biochem 2009; 42:1444-51. [PMID: 19523464 DOI: 10.1016/j.clinbiochem.2009.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 05/22/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Performance characteristics of the LOCI cTnI, CK-MB, MYO, NTproBNP and hsCRP methods on the Dimension Vista System were evaluated. DESIGN AND METHODS Imprecision (following CLSI EP05-A2 guidelines), limit of quantitation (cTnI), limit of blank, linearity on dilution, serum versus plasma matrix studies (cTnI), and method comparison studies were conducted. RESULTS Method imprecision of 1.8 to 9.7% (cTnI), 1.8 to 5.7% (CK-MB), 2.1 to 2.2% (MYO), 1.6 to 3.3% (NTproBNP), and 3.5 to 4.2% (hsCRP) were demonstrated. The manufacturer's claimed imprecision, detection limits and upper measurement limits were met. Limit of Quantitation was 0.040 ng/mL for the cTnI assay. Agreement of serum and plasma values for cTnI (r=0.99) was shown. Method comparison study results were acceptable. CONCLUSIONS The Dimension Vista cTnI, CK-MB, MYO, NTproBNP, and hsCRP methods demonstrate acceptable performance characteristics for use as an aid in the diagnosis and risk assessment of patients presenting with suspected acute coronary syndromes.
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Affiliation(s)
- Walter E Kelley
- Clinical Chemistry Labs, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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12
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Lippi G, Salvagno GL, Minicozzi AM, Montagnana M, Cordiano C, De Manzoni G, Guidi GC. Biomarkers of Myocardial Infarction in Patients Undergoing Gastrointestinal Cancer Surgery. Lab Med 2009. [DOI: 10.1309/lm1wipccvs9jmdza] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Liu JX, Li XZ, Cong WH, Fu JH, Shang XH. Effects of Corocalm (shuguan capsule) on acute myocardial ischemia in anesthetized dogs. Chin J Integr Med 2008; 13:206-10. [PMID: 17898952 DOI: 10.1007/s11655-007-0206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the effects of Corocalm (shuguan capsule) on acute myocardial ischemia in anesthetized dogs and its possible therapeutic mechanism. METHODS The acute ischemia model was established by ligating the left anterior descending (LAD) artery. Twenty-five dogs were randomly divided into 5 groups (5 dogs in each group): the control group (treated with normal saline 3 mL/kg), the refined Guanxin Capsule group (GXC 200 mg/kg), high and low dose Corocalm groups (48.5 mg/kg for low dose group and 194.0 mg/kg for high dose group) and the Diltiazem group (5 mg/kg). The animals were treated via a single duodenal administration after the model was established. The experiments used epicardial electrocardiogram (EECG) to measure the scope and degree of myocardial ischemia. Simultaneously, the coronary blood flow (CBF) and serum activity levels of creatine phosphokinase (CK) and lactate dehydrogenase (LDH) were measured by electromagnetic flow meter and automatic biochemical analyzer respectively. The plasma endothelin (ET) content was quantified by radioimmunoassay. RESULTS Corocalm (48.5 mg/kg and 194.0 mg/kg) significantly decreased the degree and scope of myocardial ischemia, reduced the infarct area, markedly increased the CBF, and inhibited the increase of CK and LDH activities and ET levels induced by myocardial ischemia/infarction. CONCLUSION Corocalm could improve the state of acute myocardial ischemia and infarction in dogs. The mechanism of action might be correlated to increasing CBF, inhibiting CK and LDH activities and preventing ET release.
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Affiliation(s)
- Jian-xun Liu
- Fundamental Medical Sciences Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Lippi G, Schena F, Montagnana M, Salvagno GL, Guidi GC. Influence of acute physical exercise on emerging muscular biomarkers. Clin Chem Lab Med 2008; 46:1313-8. [DOI: 10.1515/cclm.2008.250] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract: Although there is comprehensive information on traditional biomarkers of muscle and cardiac damage following exercise, less is known on the kinetics of innovative markers, including ischemia modified albumin (IMA), glycogen phosphorylase isoenzyme BB (GPBB), carbonic anhydrase III (CAIII) and heart-type fatty acid-binding protein (H-FABP) in athletes performing a sub-maximal exercise.: A total of 10 healthy trained Caucasian males performed a 21-km run. Blood samples were collected before the run, immediately after (post), 3, 6 and 24 h thereafter. Cardiac troponin I (cTnI), myoglobin, creatine kinase isoenzyme MB (CK-MB), GPBB, CAIII and H-FABP were assayed using a new diagnostic system based on protein biochip array technology. IMA was measured by a commercial colorimetric assay on a Roche Modular system P.: Significant variations by one-way analysis of variance were observed for CK-MB (p=0.013), myoglobin (p<0.001), GPBB (p=0.029), H-FABP (p<0.001), CAIII (p=0.006), but not for cTnI (p=1.00) and IMA (p=0.881). In particular, values of all the biomarkers tested, but cTnI and IMA, increased significantly immediately after the run. GPBB and H-FABP values returned to baseline 6 and 3 h thereafter, those of CAIII, CK-MB and myoglobin remained significantly elevated from the pre-run value up to 24 h after the run. The major variation over pre-run values was recorded for myoglobin (nearly 4-fold increment), whereas CAIII, CK-MB, GPBB and H-FABP increased by 2.9-, 1.8-, 1.4- and 1.2-fold, respectively.: We conclude that a sub-maximal aerobic exercise influences the concentration of several markers of muscle damage. Except for IMA, not one of the emerging biomarkers tested can be safely used to rule out myocardial damage as well as cardiospecific troponins in patients who had undergone recent physical activity.Clin Chem Lab Med 2008;46:1313–8.
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Effect on outcome of an increase of serum cardiac troponin T in patients with healing or healed ST-elevation myocardial infarction. Am J Cardiol 2007; 100:1723-6. [PMID: 18082515 DOI: 10.1016/j.amjcard.2007.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/03/2007] [Accepted: 07/03/2007] [Indexed: 11/20/2022]
Abstract
Recently, an association between minimally elevated cardiac troponin levels and cardiovascular risk in the general population has been reported. However, the prevalence and clinical importance of elevated cardiac troponin T (cTnT) levels remain unclear in patients with histories of myocardial infarction (MI). In this study, 1,807 consecutive patients with ST-segment elevation MIs were prospectively studied (77.1% men; mean age 64.4 years). Venous blood samples were obtained in the chronic stage of MI (28 +/- 7 days after onset), and serum cTnT levels were determined. During the average follow-up of 1,042 days, 84 patients died and 83 had nonfatal reinfarctions. Patients with cTnT levels in the highest quartile (> or = 0.040 ng/ml [n = 353]) had a higher incidence of all-cause death (8.2% vs 5.2%, p = 0.049) and nonfatal reinfarction (8.3% vs 5.1%, p = 0.048) than patients with cTnT levels from the lower 3 quartiles (<0.040 ng/ml [n = 1,064]). Multivariate Cox regression analysis revealed that a minimally elevated cTnT level (> or =0.040 ng/ml) was a significant predictor of all-cause mortality (hazard ratio 1.79, 95% confidence interval 1.10 to 2.90, p <0.02) and nonfatal reinfarction (hazard ratio 1.50, 95% confidence interval 1.13 to 2.20, p <0.03). Subgroup analysis showed that an elevated cTnT level was also a predictor of all-cause mortality and nonfatal reinfarction in patients without heart failure. In conclusion, minimally elevated cTnT levels in the chronic stage of MI predicted long-term adverse clinical outcomes.
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Mion MM, Novello E, Altinier S, Rocco S, Zaninotto M, Plebani M. Analytical and clinical performance of a fully automated cardiac multi-markers strategy based on protein biochip microarray technology. Clin Biochem 2007; 40:1245-51. [PMID: 17894935 DOI: 10.1016/j.clinbiochem.2007.07.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/12/2007] [Accepted: 07/29/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The analytical and clinical performance of the Evidence Cardiac Panel were evaluated. DESIGN AND METHODS The Evidence Cardiac Panel, an automated protein biochip microarray system, allows the simultaneous determination of creatine kinase MB (CK-MB), myoglobin (MYO), glycogen phosphorylase BB (GPBB), heart-type fatty acid-binding protein (H-FABP), carbonic anhydrase III (CA III), cardiac troponin I (cTnI). Precision: 3 levels of quality control (QC) and 2 in house pools (P) were assayed. Method comparison: MYO and cTnI concentrations measured on Evidence (E) and on Dimension RxL (D) analyzers were compared. Clinical study: 132 non-consecutive patients admitted to the Emergency Department for chest pain were enrolled. RESULTS AND CONCLUSIONS The between-day imprecision was CK-MB=6.80-10.08%; MYO=5.36-16.50%; GPBB=6.51-12.12%; H-FABP=6.26-12.63%; CA III=6.98-13.61%; cTnI=6.02-9.80%. Method comparison: E-MYO vs. D-MYO, Bias=-29.22, 95% CI from -40.25 to -18.18; E-cTnI vs. D-cTnI, Bias=-2.75, 95% CI from -4.04 to -1.46. In patients studied (at discharge: AMI, acute myocardial infarction n=42; non-AMI, n=90) H-FABP showed the highest accuracy (ROC analysis, AUC=0.92) and "cTnI+H-FABP" the greatest diagnostic efficacy (89.4%) in AMI diagnosis.
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Affiliation(s)
- Monica M Mion
- Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy
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Liu JX, Li XZ, Ma XB, Lin CR, Wang YH, Ma XY, Wang M. Cardio-protective effects of Corocalm on acute myocardial ischemia/reperfusion injury in rats. Chin J Integr Med 2006; 12:199-202. [PMID: 17005081 DOI: 10.1007/bf02836522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the cardio-protective effects of Corocalm on acute myocardial ischemia in rats, and to explore its possible therapeutic mechanisms. METHODS The acute ischemic model was prepared by ligating the left anterior descending (LAD) coronary artery in rats. The animals were divided into 6 groups, 8 in each group. The sham operated group underwent heart exposure without ligation and were treated with normal saline 3 ml/kg, while the other 5 groups, the model groups, consisted of acceptable acute ischemic model rats and were also treated with normal saline, with the Guanxin Capsule (GXC) group treated with refined GXC, 600 mg/kg, the low and high dose Corocalm groups treated with 85 mg/kg and 340 mg/kg of Corocalm respectively, and the Diltiazem group, treated with Diltiazem 5 mg/kg, with all the tested drugs prepared with normal saline into equal volume (3 ml/kg) and administrated once via duodenum 10 min before ligation. Myocardial infarction area was determined by the quantitative histological assay with nitroblue tetrazolium (N-BT) stain. And the levels of creatine phosphokinase (CK), lactate dehydrogenase (LDH), malondialdehyde (MDA) content, and the activity of superoxide dismutase (SOD) in serum were measured by biochemical assay and spectrophotometry respectively. Besides, the blood viscosity in another 50 rats was determined, who received for 7 successive days oral administration with different concentration of Corocalm or aspirin. RESULTS It showed that low and high dose Corocalm could significantly reduce the infarction area, inhibit the increase of serum CK, LDH activity and MDA content, and enhance the SOD activity after ischemia/reperfusion. The whole blood viscosity at different shear rates in rats treated with high dose Corocalm was significantly lower than those treated with normal saline (P < 0.05). CONCLUSION Corocalm has favourable protective effects on heart in ischemic condition, the effect of which might be through its actions in inhibiting CK and LDH activity, scavenging oxygen free radicals, and lowering blood viscosity.
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Affiliation(s)
- Jian-xun Liu
- Fundamental Medical Sciences Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Aslan K, Geddes CD. Microwave-Accelerated and Metal-Enhanced Fluorescence Myoglobin Detection on Silvered Surfaces: Potential Application to Myocardial Infarction Diagnosis. PLASMONICS (NORWELL, MASS.) 2006; 1:53-59. [PMID: 19444320 PMCID: PMC2678713 DOI: 10.1007/s11468-006-9006-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 01/04/2006] [Indexed: 05/24/2023]
Abstract
In this short paper, we describe a novel approach to both significantly accelerate and optically amplify fluorescence-based immunoassays. Our approach utilizes metal-enhanced fluorescence (MEF) to intrinsically optically amplify fluorescence signatures, which, when combined with the use of low-power microwaves to kinetically accelerate assays, provides for both ultrafast and ultrabright immunoassays. Surprisingly, the use of low-power microwaves and silver nanostructures provides for localized heating, concentrating the effect to the particles themselves as compared to the generic heating of the high dielectric assay fluid. We have subsequently applied our microwave-accelerated MEF approach to the detection of myoglobin, where its rapid quantification is paramount for the clinical assessment of an acute myocardial infarction.
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Affiliation(s)
- Kadir Aslan
- Laboratory for Advanced Medical Plasmonics, Medical Biotechnology Center, Institute of Fluorescence, University of Maryland Biotechnology Institute, 725 West Lombard St., Baltimore, MD 21201 USA
| | - Chris D. Geddes
- Laboratory for Advanced Medical Plasmonics, Medical Biotechnology Center, Institute of Fluorescence, University of Maryland Biotechnology Institute, 725 West Lombard St., Baltimore, MD 21201 USA
- Center for Fluorescence Spectroscopy, University of Maryland School of Medicine, 725 West Lombard St., Baltimore, MD 21201 USA
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Panteghini M. The new definition of myocardial infarction and the impact of troponin determination on clinical practice. Int J Cardiol 2006; 106:298-306. [PMID: 15950298 DOI: 10.1016/j.ijcard.2005.01.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 01/13/2005] [Accepted: 01/19/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To discuss the more controversial clinical and laboratory aspects in the application of the new biochemical diagnostic standard for myocardial infarction, 4 years after its introduction, and to make some suggestions, which could allow for a more realistic application of the new definition in the current clinical practice. METHODS Studies published in the last 4 years in the most important cardiology and laboratory medicine journals (including proceedings of the international meetings), discussing advantages and limits of the new definition of myocardial infarction, were reviewed and pertinent data were discussed and compared with similar information available in literature. RESULTS AND CONCLUSIONS Although the exact status of implementation of the new definition of myocardial infarction cannot yet be known, the trend toward such recommendation is evolving significantly, even if at different rates in different countries. To make the transition smoother, major educational efforts are required to disseminate the conceptual reasoning behind the new guidelines. On the other hand, more knowledge is needed for some relevant issues, such as the different analytical performance of cardiac troponin assays or the prognostic significance of biomarker changes after a percutaneous coronary intervention.
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Affiliation(s)
- Mauro Panteghini
- Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche Luigi Sacco, Facoltà di Medicina e Chirurgia--Polo di Vialba, Università degli Studi di Milano, Milano, Italy.
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22
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Altinier S, Zaninotto M, Mion MM, Plebani M. Innotrac Aio!: a point-of-care or a routine analyzer? Analytical performance and plasma/whole blood comparison. Clin Chem Lab Med 2006; 44:1278-82. [PMID: 17032142 DOI: 10.1515/cclm.2006.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractClin Chem Lab Med 2006;44:1278–82.
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Affiliation(s)
- Sara Altinier
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy.
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23
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Kost GJ, Tran NK. Point-of-Care Testing and Cardiac Biomarkers: The Standard of Care and Vision for Chest Pain Centers. Cardiol Clin 2005; 23:467-90, vi. [PMID: 16278118 DOI: 10.1016/j.ccl.2005.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Point-of-care testing (POCT) is defined as testing at or near the site of patient care. POCTdecreases therapeutic turnaround time (TTAT), increases clinical efficiency, and improves medical and economic outcomes. TTAT represents the time from test ordering to patient treatment. POC technologies have become ubiquitous in the United States, and, therefore,so has the potential for speed, convenience, and satisfaction, strong advantages for physicians, nurses, and patients in chest pain centers. POCT is applied most beneficially through the collaborative teamwork of clinicians and laboratorians who use integrative strategies, performance maps, clinical algorithms, and care paths (critical pathways). For example, clinical investigators have shown that on-site integration of testing for cardiac injury markers (myoglobin, creatinine kinase myocardial band [CKMB],and cardiac troponin I [cTnI]) in accelerated diagnostic algorithms produces effective screening, less hospitalization, and substantial savings. Chest pain centers, which now total over 150 accredited in the United States, incorporate similar types of protocol-driven performance enhancements. This optimization allows chest pain centers to improve patient evaluation, treatment, survival, and discharge. This article focuses on cardiac biomarker POCT for chest pain centers and emergency medicine.
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Affiliation(s)
- Gerald J Kost
- Point-of-Care Testing Center for Teaching and Research, Department of Pathology and Laboratory Medicine,UCD Health System, School of Medicine, University of California, Davis, CA 95616, USA.
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Kazmierczak SC, Sekhon H, Richards C. False-positive troponin I measured with the Abbott AxSYM attributed to fibrin interference. Int J Cardiol 2005; 101:27-31. [PMID: 15860379 DOI: 10.1016/j.ijcard.2004.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 02/24/2004] [Accepted: 03/01/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serum is often used for the measurement of cardiac troponin I (cTnI). Previous reports suggest that fibrin present in serum samples collected for cTnI analysis may interfere with measurement of this marker. We investigated the incidence and magnitude of fibrin interference in serum specimens submitted for cTnI measurement using the AxSYM analyzer by performing duplicate analysis of all specimens with increased cTnI results. METHODS Over a 4-month period, we analyzed 3692 specimens for cTnI with the Abbott AxSYM. Of these, 307 (8.3%) showed increased cTnI. A threshold of three times the precision of the method (15%) was used to judge discrepancies between duplicate analyses of specimens; all specimens being recentrifuged between the initial and repeat cTnI analyses. RESULTS Of 307 patient specimens with elevated cTnI concentrations, 24 (7.8%) demonstrated differences of greater than 45% between duplicate analyses. Concentrations of cTnI obtained on initial analysis of these 24 specimens ranged from 2.4 to 24.0 microg/l. Repeat analysis showed the repeat values for 20 (83%) to be within the normal reference interval, with 16 (67%) showing concentrations of less than 0.3 microg/l. CONCLUSIONS Our finding indicates that interference should be highly suspected in serum specimens where the initially measured cTnI concentrations is in the range of 2.0-25.0 microg/l when using the Abbott AxSYM. The finding of no interference in specimens with measured troponin concentration greater than 25.0 microg/l suggests that the interference effect of fibrin is generally not sufficient to cause spurious elevations of cTnI into this range. In addition, since switching to plasma as the specimen of choice for the AxSYM, we have not observed any discrepant cTnI results following duplicate analysis of over 200 patient samples with initial measured cTnI concentrations of 2.0 microg/l or greater.
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Affiliation(s)
- Steven C Kazmierczak
- Department of Pathology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Mailcode: L-471, Portland, OR 97239, USA.
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Lakowicz JR, Malicka J, Matveeva E, Gryczynski I, Gryczynski Z. Plasmonic technology: novel approach to ultrasensitive immunoassays. Clin Chem 2005; 51:1914-22. [PMID: 16055432 PMCID: PMC2763913 DOI: 10.1373/clinchem.2005.053199] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
At the Center for Fluorescence Spectroscopy, we have taken advantage of the favorable properties of surface plasmon-coupled emission (SPCE) to improve fluorescence-based immunoassays. SPCE occurs when excited fluorophores near conducting metallic structures efficiently couple to surface plasmons. These surface plasmons, appearing as free electron oscillations in the metallic layer, produce electromagnetic radiation that preserves the spectral properties of fluorophores but is highly polarized and directional. SPCE immunoassays provide several advantages over other fluorescence-based methods. This review explains new approaches to fluorescence immunoassays, including our own use of SPCE for simultaneous detection of more than one fluorescent marker and performance of immunoassays in the presence of an optically dense medium, such as whole blood.
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Affiliation(s)
- Joseph R Lakowicz
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Di Serio F, Amodio G, Ruggieri E, De Sario R, Varraso L, Antonelli G, Pansini N. Proteomic approach to the diagnosis of acute coronary syndrome: Preliminary results. Clin Chim Acta 2005; 357:226-35. [PMID: 15907829 DOI: 10.1016/j.cccn.2005.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 03/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cardiac multimarker strategy is recommended by the IFCC, ESC and the ACC for an early risk stratification in non-ST-segment elevation (NSTE) ECG patients with chest pain. A new approach, based on protein biochip array technology, performs simultaneously: cTnI, CK-MB, myoglobin, CAIII, GFBB and FABP using a single chip. METHODS We evaluated the analytical performance of the Randox-Evidence Investigator -biochip cardiac panel according to IFCC recommendations and NCCLS guidelines; a preliminary clinical evaluation was carried out on chest pain NSTE ECG patients, to evaluate the accuracy of the multimarker approach in an early diagnosis of AMI, related to the final diagnosis (ACC/ESC criteria). RESULTS Troponin, CK-MB and FABP methods provide reproducible within-run and between-day results (total % CVs from 5.9% to 9.7%), and myoglobin and CAIII methods showed the total % CVs from 16.4% to 25.8%. Our preliminary clinical data suggests that FABP had a better diagnostic performance (sensibility = 100%) than myoglobin (sensibility = 75%) to detect AMI in the first hours after the onset of the chest pain and myoglobin/CAIII ratio (specificity = 92.9%) improved the myoglobin specificity. CONCLUSIONS Cardiac markers have different diagnostic roles and, in this contest, biochip technology could be an interesting approach supporting clinical expectations.
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Affiliation(s)
- Francesca Di Serio
- Patologia Clinica I, University-Hospital of Bari, Piazza Giulio Cesare N. 11, Bari, Italy.
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27
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Couck P, Claeys R, Vanderstraeten E, Gorus FK. Evaluation of the Stratus CS fluorometer for the determination of plasma myoglobin. Acta Clin Belg 2005; 60:75-8. [PMID: 16082992 DOI: 10.1179/acb.2005.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Circulating myoglobin is recognized as an early and sensitive marker of acute coronary diseases. Long turnaround time of myoglobin assays jeopardize their clinical utility. We evaluated the analytical performance of the Stratus CS fluorometric enzyme immunoassay based on dendrimer technology, and claimed to achieve a fast and reliable determination of plasma myoglobin concentrations. Precision complied with the recommended analytical performance criteria. Method comparison and recovery experiments indicated, that despite good between-method correlations, the Stratus CS method overestimated myoglobin concentrations in comparison with values obtained on Cobas Integra 400 and BN A. However, since the manufacturers' cut-off for elevated plasma myoglobin levels was higher for Stratus CS than for other techniques, few discrepant results were observed between methods. Elevated levels of hemoglobin, triglycerides and rheumatoid factors did not interfere in the Stratus CS method but hyperbilirubinemia caused a positive difference.
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Affiliation(s)
- P Couck
- Laboratorium Klinische Chemie, Academisch Ziekenhuis Vrije Universiteit Brussel, Brussel, Belgie.
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28
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Jordanova N, Gyöngyösi M, Khorsand A, Falkensammer C, Zorn G, Wojta J, Anvari A, Huber K. New cut-off values of cardiac markers for risk stratification of angina pectoris. Int J Cardiol 2005; 99:429-35. [PMID: 15771924 DOI: 10.1016/j.ijcard.2004.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2003] [Revised: 02/27/2004] [Accepted: 03/01/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this present prospective study was to investigate the accuracy of cardiac markers for the prediction of subsequent cardiac events (cardiac death, acute myocardial infarction and recurrent ischemia requiring coronary revascularization). METHODS Fibrinogen, cardiac troponin T, troponin I, creatine phosphokinase myocardial fraction, C-reactive protein and myoglobin at baseline and after 6 h were measured on 154 patients (109 male, 63+/-11 years) with chest pain. Receiver operator characteristic analyses were performed to determine cut-off points of cardiac markers in prediction of adverse events. RESULTS The following cut-off values for prediction of cardiac events were calculated: troponin I at baseline 0.3 ng/ml (predictive accuracy=0.870), troponin I at 6 h 0.50 ng/ml (p.a.=0.909); troponin T at baseline 0.05 ng/ml (p.a.=0.643), troponin T at 6 h 0.05 ng/ml (p.a.=0.612), creatine phosphokinase myocardial fraction at baseline 2.0 ng/ml (p.a.=0.721), creatine phosphokinase myocardial fraction at 6 h 2.5 ng/ml (p.a.=0.734), myoglobin at baseline 23 ng/ml (p.a.=0.623), myoglobin at 6 h 26 ng/ml (p.a.=0.617), C-reactive protein at baseline 0.31 mg/dl (p.a.=0.662), C-reactive protein at 6 h 0.55 mg/dl (p.a.=0.682), and fibrinogen at baseline 360 mg/dl (p.a.=0.701). The combination of baseline troponin I with different parameters resulted in a higher sensitivity of up to 98%, with a similar predictive accuracy, but a lower specificity. Additive measurements of cardiac troponin I at 6 h to baseline cardiac troponin T and I proved to be the best combination for prediction of subsequent cardiac events. CONCLUSIONS Changes in cut-off levels of cardiac markers and inflammatory parameters results in a high accuracy of risk stratification in patients with chest pains. Combination of these measurements might further help in the identification of patients who would benefit from early coronary revascularization.
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Affiliation(s)
- Nelly Jordanova
- Division of Cardiology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Dominici R, Infusino I, Valente C, Moraschinelli I, Franzini C. Plasma or serum samples: measurements of cardiac troponin T and of other analytes compared. Clin Chem Lab Med 2005; 42:945-51. [PMID: 15387448 DOI: 10.1515/cclm.2004.154] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conflicting data in the literature concern possible differences in the immunochemical measurement of cardiac troponins, either in plasma or in serum. In order to address this specific point, 96 serum and heparin-plasma pairs were obtained for cardiac marker measurement [cardiac troponin T (cTnT); myoglobin (Myo) and creatine kinase-MB isoenzyme (CK-MB)]; 29 additional "common" analytes were measured in 77 such samples. The cardiac markers were measured by electrochemiluminescence (Elecsys 2010, Roche); the other analytes by established automated methods (Modular, Roche). Mean plasma/serum ratios for cTnT (0.95), creatine kinase-MB (1.01) and myoglobin (0.99) were comparable with those of the 29 common analytes (interval of means 0.83-1.05). The distribution of the plasma-serum differences also showed similarities between cardiac markers and other analytes. A few outlier plasma-serum differences (3-5%) were measured for both categories of analytes. Addition of heparin to serum (51 samples) caused decreased cTnT (mean ratio 0.92). In 3 of 51 such samples the cTnT decrease was more marked, but in a second sample from the same subjects (1 week later) such a prominent, heparin-induced loss of cTnT no longer appeared. In conclusion, plasma-serum differences in immuno-reactive cTnT compare with those observed for other analytes. In occasional heparin-plasma samples immunochemical measurement of cTnT may give exceptionally low values. However, in our sample group of 96 patients (cTnT lower or higher than the cut-off in, respectively, 24 and 72 patients), no misclassification occurred if plasma instead of serum cTnT values were considered.
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Affiliation(s)
- Roberto Dominici
- Laboratorio di Analisi Chimico-Cliniche, Ospedale L. Sacco, Milano, Italy
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Ilva T, Eriksson S, Lund J, Porela P, Mustonen H, Pettersson K, Pulkki K, Voipio-Pulkki LM. Improved early risk stratification and diagnosis of myocardial infarction, using a novel troponin I assay concept. Eur J Clin Invest 2005; 35:112-6. [PMID: 15667582 DOI: 10.1111/j.1365-2362.2005.01466.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the clinical performance of a novel cardiac troponin I (cTnI) assay specifically designed to improve the very early risk stratification in acute coronary syndromes. SUBJECTS AND METHODS Serum and plasma samples (taken 0, 6-12 h and 24 h after admission) from 531 patients with suspected acute coronary syndrome were studied using a novel investigational cTnI assay, reference cTnI assay and myoglobin. The lowest cTnI concentration giving a total assay imprecision of 10% was used as the positive myocardial infarction (MI) cut-off value. RESULTS At the time of admission, the investigational assay was positive in 27.9% of the patients, the reference cTnI assay was positive in only 17.5% (P < 0.001) and myoglobin in 24.1% (P = 0.067). Receiver operating characteristic (ROC) curve analysis for the detection of myocardial injury on admission gave area-under-curve (AUC) values of 0.937, 0.775 and 0.762, respectively (P < 0.001). Of those MI patients who presented within 3 h of symptom onset, 50.0% were identified by the investigational assay at the time of presentation, compared with 44.2% by myoglobin (P = 0.791) but only 11.5% by the reference assay (P < 0.001). CONCLUSIONS The novel cTnI assay considerably improves the performance of cTnI as an early rule-in biomarker for MI.
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Affiliation(s)
- T Ilva
- Department of Medicine, University of Turku, FIN-20520 Turku, Finland.
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31
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Patientennahe Bestimmung natriuretischer Peptide Near-patient testing of natriuretic peptides. ACTA ACUST UNITED AC 2005. [DOI: 10.1515/jlm.2005.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Di Serio F, Amodio G, Varraso L, Campaniello M, Coluccia P, Trerotoli P, Antonelli G, Pansini N. Integration between point-of-care cardiac markers in an emergency/cardiology department and the central laboratory: methodological and preliminary clinical evaluation. Clin Chem Lab Med 2005; 43:202-9. [PMID: 15843218 DOI: 10.1515/cclm.2005.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractTo achieve rapid assessment of chest pain in emergency/cardiology departments, a short turnaround time for cardiac marker testing is necessary. Nevertheless, Total Quality Management principles must be incorporated into the management of point-of-care testing (POCT); in this setting we implemented the Stratus CS
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Affiliation(s)
- Francesca Di Serio
- Unità Operativa di Patologia Clinica I, Policlinico di Bari, Bari, Italy.
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Matveeva E, Gryczynski Z, Gryczynski I, Malicka J, Lakowicz JR. Myoglobin immunoassay utilizing directional surface plasmon-coupled emission. Anal Chem 2004; 76:6287-92. [PMID: 15516120 PMCID: PMC6848856 DOI: 10.1021/ac0491612] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We described an immunoassay for the cardiac marker myoglobin on a thin silver mirror surface using surface plasmon-coupled emission (SPCE). SPCE occurs for fluorophores in proximity (within approximately 200 nm) of a thin metal film (in our case, silver) and results in a highly directional radiation through a glass substrate at a well-defined angle from the normal axis. We used the effect of SPCE to develop a myoglobin immunoassay on the silver mirror surface deposited on a glass substrate. Binding of the labeled anti-myoglobin antibodies led to the enhanced fluorescence emission at a specific angle of 72 degrees . The directional and enhanced directional fluorescence emission enables detection of myoglobin over a wide range of concentrations from subnormal to the elevated level of this cardiac marker. Utilizing SPCE allowed us also to demonstrate significant background suppression (from serum or whole blood) in the myoglobin immunoassay. We expect SPCE to become a powerful technique for performing immunoassays for many biomarkers in surface-bound assays.
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Affiliation(s)
- Evgenia Matveeva
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland at Baltimore, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Zygmunt Gryczynski
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland at Baltimore, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Ignacy Gryczynski
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland at Baltimore, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Joanna Malicka
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland at Baltimore, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Joseph R. Lakowicz
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland at Baltimore, 725 West Lombard Street, Baltimore, Maryland 21201
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Pagani F, Stefini F, Chapelle JP, Lefèvre G, Graïne H, Luthe H, Engelmayer J, Panteghini M. Multicenter evaluation of analytical performance of the Liaison® troponin I assay. Clin Biochem 2004; 37:750-7. [PMID: 15329312 DOI: 10.1016/j.clinbiochem.2004.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Revised: 04/14/2004] [Accepted: 04/16/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study evaluated the analytical characteristics of the Liaison immunoassay for cardiac troponin I (cTnI). DESIGN AND METHODS The protocol consisted of eight sections: evaluation of antibody specificity, linearity, detection limit and imprecision, method comparison, evaluation of endogenous interferents, anticoagulant interference, sample stability, and reference values. RESULTS The assay equally measured free and complexed cTnI. The minimum detectable cTnI concentration was 0.021 microg/l. The cTnI concentration corresponding to a total CV of 10% was 0.056 microg/l. Linearity of response was demonstrated along the entire dynamic range of the assay. Assay interferences were minimal. cTnI concentrations in serum and heparinized plasma were significantly different. Values in EDTA plasma were on average approximately 5% higher than in matched serum, but this difference was not significant. The 99th percentile cTnI value in healthy subjects was 0.036 microg/l. CONCLUSIONS Being sensitive, specific, and precise, the Liaison cTnI assay meets current requirements to aid in the diagnosis of myocardial necrosis.
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Affiliation(s)
- Franca Pagani
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera Spedali Civili, Brescia 25125, Italy
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Pérez-Cárceles MD, Noguera J, Jiménez JL, Martínez P, Luna A, Osuna E. Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease. Forensic Sci Int 2004; 142:1-7. [PMID: 15110067 DOI: 10.1016/j.forsciint.2004.02.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2002] [Accepted: 02/09/2004] [Indexed: 11/25/2022]
Abstract
In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction (n = 52); (2) asphyxia (n = 59); (3) multiple trauma (n = 41); (4) natural deaths excluding myocardial infarction (n = 36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.
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Affiliation(s)
- M D Pérez-Cárceles
- Department of Forensic Medicine, School of Medicine, University of Murcia, E-30100 Espinardo, Murcia, Spain.
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36
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Panteghini M, Linsinger T, Wu AHB, Dati F, Apple FS, Christenson RH, Mair J, Schimmel H. Standardization of immunoassays for measurement of myoglobin in serum. Phase I: Evaluation of candidate secondary reference materials. Clin Chim Acta 2004; 341:65-72. [PMID: 14967160 DOI: 10.1016/j.cccn.2003.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 10/29/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Myoglobin is a low-molecular weight protein present in the cytosol of striated muscles. Its concentrations in serum can be measured by immunoassays and are used as an early indicator of myocardial necrosis. Since variability among commercial myoglobin assays exists, standardization of myoglobin assays is needed. METHODS An international collaborative study was organized with the involvement of seven companies using 12 different automated platforms for measuring myoglobin. Five candidate secondary, i.e., matrixed, reference materials were assayed in relation to linearity, imprecision, recovery rate and commutability to demonstrate a possible identity between the materials and the usual routine serum samples. RESULTS One lyophilized candidate material (human heart myoglobin in human serum) was selected as the most suitable secondary reference material, based on the criteria examined. Used as a calibrator a posteriori, the bias between the various myoglobin assays for a frozen human serum pool was reduced from 32% to 13%. CONCLUSION This study provides the basis for the selection of an internationally recognized secondary reference material.
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Affiliation(s)
- Mauro Panteghini
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera Spedali Civili, 25125 Brescia, Italy.
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37
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Abstract
This article reviews the current contribution of the determination of biochemical markers to clinical cardiology and discusses some important developments in this field. Biochemical markers play a pivotal role in the diagnosis and management of patients with acute coronary syndrome (ACS), as witnessed by the incorporation of cardiac troponins into new international guidelines for patients with ACS and in the redefinition of myocardial infarction. Despite the success of cardiac troponins, there is still a need for development of early markers that can reliably rule out ACS from the emergency room at presentation and detect myocardial ischemia also in the absence of irreversible myocyte injury. Under investigation are two classes of indicators: markers of early injury/ischemia and markers of coronary plaque instability and disruption. Finally, with the characterization of the cardiac natriuretic peptides, Laboratory Medicine is also assuming part in the assessment of cardiac function.
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Balduini A, Campana C, Ceresa M, Arbustini E, Bosoni T, Serio A, Tinelli C, Viganò M, Melzi D'Eril GL, Tavazzi L, Moratti R, Merlini G. Utility of biochemical markers in the follow-up of heart transplant recipients. Transplant Proc 2003; 35:3075-8. [PMID: 14697983 DOI: 10.1016/j.transproceed.2003.10.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endomyocardial biopsy (EMB) is currently the standard method to diagnose acute graft rejection. However, considering the potential complications of this procedure, a noninvasive marker of rejection would be an ideal alternative or at least a helpful adjunct to posttransplant management. We measured myoglobin (Myo), creatine kinase MB mass (CK-MBm), troponin T (cTnT), serum amyloid A (SAA), and C-reactive protein (CRP) in 57 patients (mean age 37.5 years) who underwent orthotopic heart transplantation for end-stage cardiac failure between January and December 2001.Endomyocardial biopsies were performed routinely after surgery and histologically diagnosed rejection was graded according to the criteria of the International Society of Heart and Lung Transplantation. Concomittant with the biopsies, blood samples were drawn from the coronary sinus (central blood samples) and from a peripheral vein (peripheral blood samples) to assay biochemical markers. Among 149 EMB evaluated, 87 were negative (grade 0); 28 showed grade 1a rejection; 26 showed grade 1b; and 8 showed grade > 1b (2 were grade 2, 6 were grade 3a). Grades 0 and 1a were considered to be negative, while grades 1b and >1b were considered positive indicating potential acute graft rejection. cTnT, Myo, CK-MBm, SAA, and CRP levels were measured in 149 central blood samples and 149 peripheral blood samples. Myo and CK-MBm did not show significant changes. cTnT seems to be a potentially useful addition to the EMB results, while SAA and CRP showed variations with respect to EMB grade both in central and peripheral samples.
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Affiliation(s)
- A Balduini
- Biotechnology Research and Clinical Chemistry Laboratories, Department of Biochemistry, University of Pavia, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia, Italy
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39
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Vatansever S, Akkaya V, Erk O, Oztürk S, Karan MA, Salmayenli N, Taşçioğlu C, Güler K. The diagnostic value of troponin T and myoglobin levels in acute myocardial infarction: a study in Turkish patients. J Int Med Res 2003; 31:76-83. [PMID: 12760310 DOI: 10.1177/147323000303100203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study compares the diagnostic value of troponin T (TnT) and myoglobin with creatinine kinase (CK) for myocardial infarction (MI) in a tertiary care centre in a developing nation. The study group comprised 33 acute myocardial infarction patients and 27 healthy controls. Receiver operating characteristic curves for TnT, myoglobin and CK were drawn and areas under the curve calculated. At admission, myoglobin levels had greater diagnostic sensitivity than TnT or CK levels. After 2 h, myoglobin and TnT had equal sensitivity and specificity, whereas CK still had lower sensitivity than myoglobin and TnT. After 4 h there was no difference between the tests. It was concluded that myoglobin levels on admission and TnT at 2 h had the greatest diagnostic rate, whereas all the tests were similar after 4 h for MI.
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Affiliation(s)
- S Vatansever
- Department of Internal Medicine, Division of Emergency Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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40
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Di Serio F, Trerotoli P, Serio G, Varraso L, Pansini N. Analytical Evaluation of an Automated Immunoassay for Cardiac Troponin I: The Vidas Troponin I Assay. Clin Chem Lab Med 2003; 41:1363-8. [PMID: 14580167 DOI: 10.1515/cclm.2003.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac troponin I (cTnI) is a sensitive and specific biochemical marker of myocardial damage. We assessed the analytical performance of the Vidas Troponin I assay (Biomerieux). Controls and serum pools were used to determine the precision, analytical sensitivity and linearity; 97.5 and 99.5 percentiles concentrations were determined from the reference population. Fifty corresponding samples of serum and plasma (lithium-heparin) were tested and the results compared. The in vitro stability of serum and plasma samples was assessed at 20 degrees C, 4 degrees C and -20 degrees C, respectively. Samples of serum were used to assess the agreement between the Vidas Troponin I method and the revised Dimension RxL cTnI method (Dade-Behring). The total imprecision (CVs) was 13.1-5.2% for concentrations ranging between 0.25 and 19.8 microg/l cTnI. The lower detection limit was <0.1 microg/l. The upper reference limit (97.5 and 99.5 percentiles) was 0.11 microg/l and 0.12 microg/l, respectively (CV > 10%). The assay was linear up to 21 microg/l. The concentrations in lithium-heparin plasma were higher compared to those of the matched serum samples. The study of the agreement between the Vidas and Dimension RxL cTnI assays showed a total concordance of 96% with a bias value of -0.042. The Vidas Troponin I test is a fast, precise and sensitive method for the determination of cTnI.
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Affiliation(s)
- Francesca Di Serio
- Unità Operativa di Patologia Clinica I, Policlinico di Bari, Bari, Italy.
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41
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Abstract
New biomarkers, such as cardiac troponins, have a major role to play for cost-effective management of individuals with acute chest pain and suspected coronary syndrome, and the laboratory is now poised to assume a vital role in assessing damage and determining prognosis. The redefined biochemical criterion proposed to classify acute coronary syndrome patients presenting with ischemic symptoms as patients with myocardial infarction is heavily predicated on an increased troponin concentration in blood. In an era of evidence-based medicine, we can no longer overlook the diagnostic and prognostic benefits provided by the measurement of these highly sensitive and specific proteins.
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Affiliation(s)
- Mauro Panteghini
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera Spedali Civili, 25125 Brescia, Italy.
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42
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Bock JL. Test strategies for the detection of myocardial damage. Clin Lab Med 2002; 22:357-75. [PMID: 12134465 DOI: 10.1016/s0272-2712(01)00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the space of half a century, cardiac marker testing has advanced incrementally from enzymes present in nearly all tissues to proteins having remarkable specificity for myocardium. Markers with other desirable properties, such as earlier release, have also been introduced and others may be anticipated, although a single perfect marker is not on the horizon. Optimum application of these new markers still requires improved robustness and harmonization of commercial assays, and continuing insights in the pathophysiology of acute coronary syndromes. As these advances occur, future testing will likely focus more on therapeutic decisions than on arbitrary diagnostic classifications.
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Affiliation(s)
- Jay L Bock
- Department of Pathology, University Hospital and Medical Center, Stony Brook University, Stony Brook, NY 11794-7300, USA.
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Abstract
The development of commercial assays for the determination of new cardiac proteins has been one of the most important innovations in the field of cardiovascular diagnostics in the last decade. This significant and sudden advancement has however led to some analytical and interpretative problems. There are problems in test standardization, imprecision, interference and preanalytical variability. We also need to standardize utilization of biomarkers in diagnosis and management of acute cardiac syndromes and clearly define decision thresholds. Powerful tests, such as cardiac markers, on which critical decisions will rest, need highly reliable methods. The feeling is that some assays are inadequately appraised prior to their introduction in clinical use. More studies are needed to implement new devices in the laboratory routine, and only well documented assays should be used in hospital-based laboratories. The technology to address many analytic problems is at hand, but commitment on the part of manufacturers and their customers in the laboratory community is essential.
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Affiliation(s)
- M Panteghini
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera Spedali Civili, Brescia, Italy.
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45
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Abstract
Testing for the diagnosis of acute myocardial infarction and other diseases included in the spectrum of the so-called "acute coronary syndrome" is rapidly changing from the traditional enzymatic assays to mass measurement of more specific and sensitive markers (cardiac troponins, CK-MB and myoglobin). Several questions have arisen since the introduction of these new markers into the clinical setting: the choice of strategies for optimizing the utilization of biochemical assays combining different (early and specific) markers, the rationale for sampling specimens and the identification of clinically useful turnaround times. The impressive clinical specificity and sensitivity assured by the measurement of cardiac troponins should be used for improving the effectiveness of patients' diagnosis and treatment. Troponins could be the paradigm of how a new diagnostic test and a therapeutic advance can be combined to the benefit of patients with acute coronary syndromes. In fact, in acute myocardial infarction (AMI) patients as well as in patients suffering from stable and unstable angina, the measurement of troponins alone, or combined to that of other biochemical markers, should be of practical value for the diagnosis, for the prognosis and for selecting the most effective therapeutic treatment. Limitations in cardiac markers should be classified into two groups: temporary and intrinsic limitations. Temporary limitations are: (a) current assays are not specific as to the analyte, (b) the limited standardization precludes a comparison between results obtained with different techniques. Intrinsic limitations are the elevation of troponins in the so-called "minor myocardial damage", which often cannot be confirmed by other techniques, the evidence that other heart diseases, such as congestive heart failure and myocarditis, can lead to an increase in troponin concentrations, and finally that troponin is not an early marker. A sound cooperation between cardiologists, physicians and laboratory specialists in explaining and understanding the advantages and limitations of current biochemical markers should allow us to move from efficiency to clinical effectiveness.
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Affiliation(s)
- M Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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46
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Altinier S, Zaninotto M, Mion M, Carraro P, Rocco S, Tosato F, Plebani M. Point-of-care testing of cardiac markers: results from an experience in an Emergency Department. Clin Chim Acta 2001; 311:67-72. [PMID: 11557257 DOI: 10.1016/s0009-8981(01)00562-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM An experimental approach to the use of point-of-care testing for cardiac markers in the Emergency Department (ED) of our Institution has been carried out using two devices (SCS, Dade Behring and Triage Cardiac Panel, Biosite Diagnostics) for the measurement of cardiac markers. RESULTS (1) From the analytical point of view, a fundamental tool for an efficient management of patients was the agreement between results from point-of-care testing and from the instruments located in STAT lab and/or central laboratory: in about 5% of patients, a lack of comparability of data, resulted in an inappropriate admission of patients (medical vs. intensive care unit). (2) The actual total turnaround time (TAT) in the management of samples sent to STAT lab was estimated to be equal to 82.5 min (50th percentile). (3) In the same organizational setting, the use of a point-of-care device produced a turnaround time equal to 17 min (50th percentile). (4) The reduction in turnaround time resulted in a faster discharge for five patients who had normal ECG findings and cardiac marker values, the Delta time (POCT-STAT lab) ranging from -10 to -70 min. CONCLUSIONS The point-of-care option evaluated also in relation to personnel issues for staff working in the ED, brought some interesting questions about the characteristics of POCT devices (easy to use 100%, safety for operator 91%) and the obtained results (quantitative and correlated to STAT lab, 91%), as well as the need of other options such as the implementation of rapid tube sample delivery.
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Affiliation(s)
- S Altinier
- Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani, 2, 35128 Padua, Italy
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47
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Affiliation(s)
- D Naidoo
- Department of Clinical Chemistry, The Prince of Wales Hospital, Randwick, NSW, Australia.
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48
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Pagani F, Bonetti G, Panteghini M. Comparative study of cardiac troponin I and T measurements in a routine extra-cardiological clinical setting. J Clin Lab Anal 2001; 15:210-4. [PMID: 11436204 PMCID: PMC6808045 DOI: 10.1002/jcla.1029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study compared troponin I (cTnI) to troponin T (cTnT) in a population admitted to General Medicine Divisions in whom acute myocardial infarction (AMI) was suspected; 98 consecutive patients were included. Diagnoses were made without knowledge of troponin results: 51 patients had AMI, and 47 (including 8 with unstable angina) had no AMI. Patients were considered to be troponin positive if the marker concentration was >99th percentile value of the reference population. Both troponins were associated with an almost absolute sensitivity for AMI (100% for cTnI and 98.0% for cTnT), while the specificity was marginally higher for cTnI (78.7% vs. 68.1%). Increased cTnI and/or cTnT were observed in 15 patients out of 39 without acute coronary syndromes. Simultaneous positivity was seen in 8 patients with severe disorders and complications. Discordances were more frequent in favor of increased cTnT (n = 5) than the opposite (n = 2), even if this difference did not achieve statistical significance. cTnI and cTnT detected AMI with comparable efficiency. Cases without coronary syndrome positively concordant for troponins confirmed the ability of these biomarkers to detect myocardial injury undetectable by conventional diagnostic approaches.
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Affiliation(s)
- Franca Pagani
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera “Spedali Civili”, Brescia, Italy
| | - Graziella Bonetti
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera “Spedali Civili”, Brescia, Italy
| | - Mauro Panteghini
- Laboratorio Analisi Chimico Cliniche 1, Azienda Ospedaliera “Spedali Civili”, Brescia, Italy
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Cattozzo G, Finazzi S, Ferrarese S, Sala A, Melzi d'Eril GV. Serum cardiac troponin I after conventional and minimal invasive coronary artery bypass surgery. Clin Chem Lab Med 2001; 39:392-5. [PMID: 11434387 DOI: 10.1515/cclm.2001.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated myocardial release of cardiac troponin I (cTnI) in patients treated with conventional coronary artery bypass grafting (CABG), which employs extracorporeal circulation, and different kinds of minimal invasive coronary artery bypass grafting (MICABG), a surgical technique where the operation is performed without extra-corporeal circulation. Furthermore, we evaluated the usefulness of serum cTnI measurement to detect perioperative myocardial infarction (PMI) after coronary artery bypass surgery. Thirty-one patients were included: sixteen underwent CABG, fifteen underwent different MICABG and five patients had PMI. Blood specimens for cTnI measurements were collected up to 72 hours after opening the graft. Aortic cross-clamping time was a minor determinant of myocardial damage; on the other side, the trauma during surgery correlated with the number of involved arteries and with the manoeuvre employed to obtain heart dislocation, and appeared a more important determinant of myocardial damage. In patients with PMI, the cumulative release of cTnI was higher than in patients free from PMI; however, only after 24-72 hours we observed significant differences in serum cTnI values, because the increased perioperative values of cTnI complicated the interpretation of the myocardial status and a single cut-off could not be used to exclude PMI.
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Affiliation(s)
- G Cattozzo
- Laboratorio di Analisi, Ospedale Del Ponte-A. O. Fondazione Macchi, Varese, Italy.
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50
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Panteghini M, Gerhardt W, Apple FS, Dati F, Ravkilde J, Wu AH. Quality specifications for cardiac troponin assays. Clin Chem Lab Med 2001; 39:175-9. [PMID: 11341755 DOI: 10.1515/cclm.2001.39.2.175] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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