High-Sensitivity Assays for Troponin in Patients with Cardiac Disease !

Troponin is a widely used biomarker in patients with cardiac disease. The use of troponin is well established in patients with suspected acute myocardial infarction (AMI), but troponin measurement is also used in other acute and nonacute settings. In patients with suspected AMI, early decision-making is crucial to allow rapid treatment and further diagnostic evaluation. Current guidelines recommend serial measurements of troponin with a cut-off concentration at the 99th percentile to triage patients in the emergency department.

Newer, high-sensitivity assays for troponin enable the detection of distinctly lower concentrations. Using these assays and very low cut-off concentrations, several rapid diagnostic strategies have been reported to improve diagnosis in acute cardiac care. Furthermore, noncoronary and non-acute applications of troponin assays — for example as a biomarker in patients with heart failure, pulmonary embolism, or stable coronary artery disease — are on the horizon and might improve individual risk stratification.

In this Review, we provide an overview on the development of high-sensitivity assays for troponin, and their application in patients with cardiac disease.

Pathophysiological background of troponin and troponin release

in different settings. A schematic overview of myocardial structure

related to troponin (inset), as well as the plasma troponin concentrations 

in different clinical settings (young and healthy, elderly or chronic diseases,

myocardial injury, and myocardial infarction).

Read more: High-Sensitivity Assays for Troponin in Patients with Cardiac Disease !

Source: NatureReviewsCadiology

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Cardiac Biomarkers and Clinical Decision Making

New video discusses the importance of cardiac biomarkers

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In this video, hear from a former operating engineer at the White House who, despite an active lifestyle and basic good health, experienced sudden heart failure. In the context of his healthcare journey, the video highlights the role of cardiac biomarkers in clinical decision making and the diagnosis of a heart attack.

Diagnosed with advanced coronary artery disease, the patient underwent cardiac bypass surgery and was enrolled in a biomarker study during his postoperative course of treatment. “There’s no doubt that biomarkers have completely transformed how we care for our patients in cardiovascular medicine,” says the patient’s cardiologist.

The Growing Impact of Cardiac Biomarkers in Clinical Chemistry.

Clinical chemistry measurements and calculations take into account an expansive set of analytes that reflect cardiac, liver, kidney, and other biological functions. Several of these discrete analytes are considered biomarkers, defined by Strimbu and Tavel as “a broad subcategory of medical signs [that are] objective indications of medical state observed from outside the patient which can be measured accurately and reproducibly.” In the case of cardiac biomarkers, the most common analytes are creatine kinase (CK), lactate dehydrogenase (LDH), and troponin (TNI). There are pros and cons to using these common chemistry tests as definitive cardiac biomarkers. However, other chemistry analytes and even some non-laboratory tests have been identified as potential cardiac biomarkers. Providing clinicians with accurate and thorough testing is important in contributing to diagnosis and ultimately to positive patient outcomes.

Read more: The Growing Impact of Cardiac Biomarkers in Clinical Chemistry.

Source: MedicalLaboratoryObserver

New Gene Associated With Familial High Cholesterol

The gene that explains one quarter of all familial hypercholesterolemia with very high blood cholesterol has been revealed. Familial hypercholesterolemia is the most common genetic disorder leading to premature death, found in 1 in 200 people.

The reason why lipoprotein(a) concentrations are raised in individuals with clinical familial hypercholesterolemia is unclear. The hypotheses that high lipoprotein(a) cholesterol and LPA risk genotypes are a possible cause of clinical familial hypercholesterolemia, and that individuals with both high lipoprotein(a) concentrations and clinical familial hypercholesterolemia have the highest risk of myocardial infarction.

Read more: New Gene Associated With Familial High Cholesterol

Clinical manifestation of Homozygous Familial Hypercholesterolemia, interdigital xanthoma

Source: labmedica

Heart Attack Patients Are Getting Younger and More Obese.

Young people tend to feel invincible to danger, but they're not, especially when it comes to their heart health. One of the most common misconceptions about heart health is that older people are the only ones who need to worry. 

Patients who suffer from the most severe and deadly type of heart attack, STEMI, are getting younger and more obese, according to Dr. Samir Kapadia, professor of medicine and section head for interventional cardiology at Cleveland Clinic.

"On the whole, the medical community has done an outstanding job of improving treatments for heart disease, but this study shows that we have to do better on the prevention side," said Kapadia in a statement. "When people come for routine checkups, it is critical to stress the importance of reducing risk factors through weight reduction, eating a healthy diet, and being physically active." He presented his research at the American College of Cardiology's 65th Annual Scientific Session.

Read more: Heart Attack Patients Are Getting Younger and More Obese.

Video link: Younger obese people are at risk of getting heart attacks!

Source: HealthDay

Cardiovascular Disease Diagnostics and Testing

Current and emerging cardiac markers signal improved testing for better patient outcomes

Cardiovascular diseases continue to be the leading cause of death in the United States, responsible for nearly 800,000 deaths annually—or about one in every three deaths. Heart disease is the leading cause of death for both men and women, claiming the lives of about 610,000 Americans each year.1Coronary artery disease is the most common type of heart disease, killing more than 370,000 people annually.

In addition, about 5.1 million people in the United States have heart failure.2About half of the people who develop heart failure die within 5 years of diagnosis. In 2009, one out of every nine deaths included heart failure as a contributing cause. Heart failure costs the nation an estimated $32 billion each year.

In light of such dire statistics, it’s no wonder that achieving speedy diagnosis of acute myocardial infarction (AMI)—heart attack—remains a significant concern in emergency departments throughout the nation. Early triage of patients to rule-in or rule-out AMI is challenging. For many years, testing for the presence of the regulatory proteins troponin I or troponin T—both released into the bloodstream when the heart muscle has been damaged—has been the gold standard for diagnosing AMI. But recent reports have indicated that the latest generation of high-sensitivity troponin tests can increase diagnostic efficiency and improve early diagnosis of myocardial infarction.

Read more: Cardiovascular Disease Diagnostics and Testing

Alere’s troponin I test is a cartridge-based high-sensitivity immunoassay.

Source: clpmag