The use of biomarkers for acute cardiovascular disease

Cardiac Troponin ◽

Clinical Information ◽

Clinical Use ◽

Troponin Level ◽

Upper Limit ◽

New Generation

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The bene?ts of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.

The use of biomarkers for acute cardiovascular disease

10.1093/med/9780199687039.003.0035 ◽

2015 ◽

Author(s):

Allan S Jaffe

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Cardiac Troponin ◽

Clinical Information ◽

Clinical Use ◽

Troponin Level ◽

Upper Limit ◽

New Generation

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The bene?ts of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.

The use of biomarkers for acute cardiovascular disease

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0032 ◽

2021 ◽

pp. 387-399

Author(s):

Allan S Jaffe

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Cardiac Troponin ◽

Clinical Information ◽

Clinical Use ◽

Troponin Level ◽

Upper Limit ◽

New Generation

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The benefits of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.

Single vs Serial Measurements of Cardiac Troponin Level in the Evaluation of Patients in the Emergency Department With Suspected Acute Myocardial Infarction

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.37930 ◽

2021 ◽

Vol 4 (2) ◽

pp. e2037930

Author(s):

Maereg Wassie ◽

Ming-Sum Lee ◽

Benjamin C. Sun ◽

Yi-Lin Wu ◽

Aileen S. Baecker ◽

...

Keyword(s):

Myocardial Infarction ◽

Suspected Acute Myocardial Infarction

Emergency Department ◽

Cardiac Troponin ◽

Troponin Level ◽

Serial Measurements ◽

Is copeptin ready for clinical use in a dual-marker strategy with high-sensitivity cardiac troponin to rule-out acute myocardial infarction?

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.11.110 ◽

2019 ◽

Vol 276 ◽

pp. 271-272

Author(s):

Ana Teresa Timóteo

Keyword(s):

Myocardial Infarction ◽

Cardiac Troponin ◽

High Sensitivity ◽

Clinical Use ◽

Rule Out

Predicting Acute Myocardial Infarction with a Single Blood Draw

Clinical Chemistry ◽

10.1373/clinchem.2018.294124 ◽

2019 ◽

Vol 65 (3) ◽

pp. 437-450 ◽

Cited By ~ 4

Author(s):

Jasper Boeddinghaus ◽

Thomas Nestelberger ◽

Patrick Badertscher ◽

Raphael Twerenbold ◽

Brigitte Fitze ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Cardiac Troponin ◽

Clinical Information ◽

High Sensitivity ◽

Diagnostic Study ◽

Blood Draw ◽

Serial Sampling ◽

Clinically Significant

Abstract BACKGROUND We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography. METHODS In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes. RESULTS Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6–49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7–82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5–86.7) for >80 ng/L vs 83.9% (95% CI, 76.0–90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations. CONCLUSIONS Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way. ClinicalTrials.gov Identifier NCT00470587.

ACUTE MYOCARDIAL INFARCTION;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.06.1731 ◽

2013 ◽

Vol 20 (06) ◽

pp. 871-875

Author(s):

MUHAMMAD SHAFIQ ◽

MUHAMMAD AKRAM ◽

M. NASARULLAH KHAN NASSER

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Negative Predictive Value ◽

Predictive Value ◽

Cardiac Troponin ◽

Troponin I ◽

Limit Value ◽

Creatine Kinase Mb

A delay in confirming a diagnosis of AMI may increase the risk of complication and a delay in ruling out the diagnosiscontributes to overcrowding in the emergency department. A crucial step in confirming or ruling out the diagnosis of AMI is themeasurement of myocardial enzymes in the serum. Early administration of thrombolytic therapy results in improved survival after AMI. Sothis study was planned to find out the serum marker with a better predictive value for the identification of acute myocardial infarction at thetime of admission. Design: Cross-sectional study. Setting: Emergency department of Punjab Institute of Cardiology, Lahore. Period:15th May, 2008 to 15th July, 2008. Methods: The study population consisted of 70 patients. Patients from both sexes, with clinicalhistory of typical chest pain for more than 30 minutes in duration with evidence of acute changes of myocardial infarction on ECG wereincluded in the study. This study was conducted to compare the positive predictive value and negative predictive value of creatine kinase-MB (CK-MB), cardiac troponin T (CTnT) and cardiac troponin I (CTnI) for detection of AMI. Data analysis was performed with StatisticalPackage for Social Sciences 11.5 (SPSS 11.5). Results: 88.6% cases had CTnI concentration more than the limit value while 11.4%cases had CTnI less than the limit value. The concentration of CTnT was more than the limit value in 70% cases and below the limit value in30% cases. The concentration of CK-MB was more than the limit value in 35.7% cases and 64.3% cases had CK-MB value less than thelimit value. The positive predictive value (PPV) of CtnI is 100% and negative predictive value (NPV) of CTnT is 100% in this study.Conclusions: It is concluded that CTnl is the better marker for the identification of acute myocardial infarction and CTnT is the bettermarker to exclude AMI as compared to CK-MB.