scholarly journals The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary Syndromes

2009 ◽  
Vol 28 (4) ◽  
pp. 293-299 ◽  
Author(s):  
Grazyna Sypniewska ◽  
Marcin Sawicki ◽  
Magdalena Krintus ◽  
Marek Kozinski ◽  
Jacek Kubica
Keyword(s):  
Early Diagnosis ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Myocardial Injury ◽  
Troponin I ◽  
Reference Population ◽  
Coronary Syndrome ◽  
Carbonic Anhydrase Iii ◽  
Array Technology ◽  
Coronary Syndromes

The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary SyndromesSerum troponin is the best biomarker for the diagnosis of acute coronary syndrome, but it takes considerable time before a definitive diagnosis is available. The purpose of this study was to evaluate whether a multimarker approach, using the biochip cardiac array, would facilitate the early diagnosis. Serum biomarkers were determined on admission (≤6 hrs) and after 6 hours in 42 patients suspected for ACS. Cardiac troponin I was measured by a sensitive assay (STATcTnI) and cardiac markers (H-FABP, myoglobin, cTnI, CK-MB mass, carbonic anhydrase III) were assayed with the use of Biochip Array Technology.STATcTnI concentrations, within the first 6 hours, were elevated >99thpercentile for the reference population in 83.3% of subjects, but none reached the cut-off for AMI. On admission H-FABP was the only marker with 90.5% sensitivity in all ACS cases and 100% sensitivity in STEMI/NSTEMI patients. The sensitivity of myoglobin at presentation was 71.4% in ACS, however, combined sensitivity of myoglobin and H-FABP reached 95.2%. Lowering the cut-off for cTnI allowed early diagnosis (≤6 hrs) in only 26.2% of ACS patients and 95.2% after the next 6 hours. In unstable angina the cardiac panel was not sufficiently accurate for early risk stratification. In conclusion, testing for both markers, H-FABP and sensitive cardiac troponin, available with the cardiac array may facilitate the early detection of myocardial injury in clinical practice.

scholarly journals Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

2009 ◽  
Vol 55 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Kai M Eggers ◽  
Allan S Jaffe ◽  
Lars Lind ◽  
Per Venge ◽  
Bertil Lindahl
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Reference Population ◽  
Cardiac Troponin I ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background: The aim of this study was to evaluate factors influencing the 99th percentile for cardiac troponin I (cTnI) when this cutoff value is established on a highly sensitive assay, and to compare the value of this cutoff to that of lower cutoffs in the prognostic assessment of patients with coronary artery disease. Methods: We used the recently refined Access AccuTnI assay (Beckman-Coulter) to assess the distribution of cTnI results in a community population of elderly individuals [PIVUS (Prospective Study of the Vasculature in Uppsala Seniors) study; n = 1005]. The utility of predefined cTnI cutoffs for risk stratification was then evaluated in 952 patients from the FRISC II (FRagmin and Fast Revascularization during InStability in Coronary artery disease) study at 6 months after these patients had suffered acute coronary syndrome. Results: Selection of assay results from a subcohort of PIVUS participants without cardiovascular disease resulted in a decrease of the 99th percentile from 0.044 μg/L to 0.028 μg/L. Men had higher rates of cTnI elevation with respect to the tested thresholds. Whereas the 99th percentile cutoff was not found to be a useful prognostic indicator for 5-year mortality, both the 90th percentile (hazard ratio 3.1; 95% CI 1.9–5.1) and the 75th percentile (hazard ratio 2.8; 95% CI 1.7–4.7) provided useful prognostic information. Sex-specific cutoffs did not improve risk prediction. Conclusions: The 99th percentile of cTnI depends highly on the characteristics of the reference population from which it is determined. This dependence on the reference population may affect the appropriateness of clinical conclusions based on this threshold. However, cTnI cutoffs below the 99th percentile seem to provide better prognostic discrimination in stabilized acute coronary syndrome patients and therefore may be preferable for risk stratification.

Abstract 18945: Baseline Myocardium At-Risk Predicts Subsequent Myocardial Injury in Non ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Henry Chang ◽  
Jennifer A Dickerson ◽  
David Verhaert ◽  
Orlando P Simonetti ◽  
Giuseppe Ambrosio ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Acute Coronary Syndromes ◽  
Myocardial Injury ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes ◽  
Myocardium At Risk

BACKGROUND: Increased myocardial injury visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) portends worse outcomes in patients with acute coronary syndromes (ACS). Although non ST-segment acute coronary syndromes (NSTE-ACS) comprise 70% of all ACS and 1-year mortality rates are similar to the more readily-diagnosed and uniformly-treated ST-elevation myocardial infarction, ischemic changes and treatment strategies in NSTE-ACS are not well-defined, Studies have shown that T2-weighted (T2W) cardiac magnetic resonance (CMR) may be a marker of acute myocardial injury in ACS. We hypothesized that the presence of at-risk myocardium, identified by T2W CMR at presentation, predicts increased subsequent myocardial injury by LGE beyond traditional risk predictors in NSTE-ACS. METHODS & RESULTS: 48 patients enrolled in a prospective study of NSTE-ACS underwent CMR with short tau inversion recovery (T2W STIR) imaging and LGE prior to intervention and repeat CMR 61 ± 27 days later. Baseline presence/absence of increased myocardial signal intensity by T2W STIR was determined by consensus of two expert reviewers blinded to other data. In 13 patients (27%), follow-up LGE images showed more extensive injury compared to baseline. Peak troponin at time of event, baseline TIMI risk score and baseline LGE score did not predict subsequent LGE score increase (p=0.13, p=0.48, p=0.55, respectively). Conversely, a much higher proportion of patients with vs. without increased T2W STIR SI at baseline demonstrated increased myocardial injury by LGE at follow-up (12/31 vs. 1/17, p<0.01; Figure). CONCLUSION: Myocardium at-risk by T2-weighted STIR CMR in patients with NSTE-ACS predicts subsequent myocardial injury, more so than clinical predictors or extent of baseline myocardial damage. Prospective studies that intensify care for patients with at-risk myocardium may help identify strategies to improve myocardial salvage and reduce mortality in NSTE-ACS.

Biomarkers in acute coronary syndromes

2017 ◽  
Author(s):  
Evangelos Giannitsis ◽  
Hugo A Katus
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Pharmacological Therapy ◽  
Individual Risk ◽  
Strict Adherence ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Rule Out

Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among normal-troponin subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.

scholarly journals Validation of High sensitivity cardiac troponin (HsTnI) – a breakthrough in diagnostic accuracy of acute coronary syndromes

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
S Dalal ◽  
J M Petersen ◽  
D Jhala
Keyword(s):  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Method Comparison ◽  
Heart Association ◽  
High Sensitivity ◽  
Coronary Syndromes ◽  
European Society Of Cardiology

Abstract Introduction/Objective Cardiac troponin (cTn) testing is an essential component of the diagnostic workup and management of acute coronary syndromes (ACS). Rapid advances in immunoassay technologies has led to the development of high sensitivity troponin (HsTnl) assays with unprecedented analytic sensitivity and precision. These assays are FDA approved and the use of HsTnl assays is recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the Joint European Society of Cardiology (ESC), the American College of Cardiology (ACC), and the American Heart Association (AHA) in the Fourth Universal Definition of Myocardial Infarction (2018). The incidence of ACS and its mimics in emergency room visits are much more prevalent in veterans due to increased medical comorbidities. We report here our experience with its validation on two Unicel DXI 800 Access Immunoassays as it has not been well published, particularly in a Veterans Healthcare Clinical Laboratory setting. Methods/Case Report The quality assurance goal of the validation is to demonstrate that the Unicel DXI 800 Access Immunoassay HsTnl assay performs as expected on two analyzers and can be put into clinical use. Method to method correlation with a validated conventional Troponin I, within run precision, day to day precision, and a linearity study were performed as part of this validation. Results (if a Case Study enter NA) For the total of 60 specimens run for the method comparison, Data was plotted and evaluated against EP evaluator, both hsTnI and Troponin I were within the 95% confidence intervals of the method. The linearity study demonstrated results are linear with results as expected. Two levels of cardiac control were tested in a run of 60 replicates each in one day for within run precision, with all results as expected. The day to day precision with three levels of control run daily over 10 days also yielded results as expected. Conclusion The HsTnI is a highly accurate, faster test for the detection of ACS allowing earlier detection of smaller infarcts with much better precision, and there by reducing the morbidity and mortality. It allows rapid discharge of the patients with reducing the cost of hospital stay. This is an example of excellence in laboratory practice by extending the best quality laboratory care with proper validation of instrument methods conducive to laboratory workflow.

scholarly journals Allergic acute coronary syndrome: Amoxicillin/clavulanic acid intake

2021 ◽  
Vol 11 (2) ◽  
pp. 064-068
Author(s):  
Filipa Ribeiro Lucas ◽  
João Gigante ◽  
Steve Harakeh ◽  
Pedro Vieira
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Myocardial Injury ◽  
Kounis Syndrome ◽  
Laboratory Findings ◽  
Coronary Syndrome ◽  
Antibiotic Allergy ◽  
Allergen Concentration ◽  
Amoxicillin Clavulanic Acid ◽  
Coronary Syndromes

Anaphylaxis rarely manifests as a vasospastic acute coronary syndrome (ACS). Kounis Syndrome (KS) is described as the coincidental occurrence of chest pain and clinical and laboratory findings of ACS. The prognosis depends on the magnitude of the initial allergic response, the patient’s sensitivity, comorbidities, the site of antibody antigen reaction, the allergen concentration, and the route of allergen entrance. We report a rare case of KS secondary to antibiotic allergy. This case may suggest that Kounis syndrome should be taught in the differential diagnosis of acute coronary syndromes. Clinicians should be aware of this adverse effect and consider it during diagnostic workup of myocardial injury.

scholarly journals NILAI DIAGNOSTIK UJI TROPONIN I KUANTITATIF METODE IMMUNOKROMATOGRAFI

2018 ◽  
Vol 14 (1) ◽  
pp. 20
Author(s):  
Siti Fatonah ◽  
Anik Widijanti ◽  
Tinny Endang Hernowati
Keyword(s):  
Cardiac Troponin ◽  
Biochemical Markers ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Myocardial Damage ◽  
Diagnostic Value ◽  
Cardiac Troponin I ◽  
Coronary Syndromes ◽  
Sensitivity Specificity ◽  
Cardiac Troponins

Cardiac troponins are the most sensitive and specific biochemical markers of myocardial damage but there is no standardization of WHO for cardiac troponin I, resulting in a variability for diagnostic value. It is necessary to determine diagnostic value for a new kitof troponin I. To evaluate a new quantitative immunochromatography assay for troponin I at a various cut off level. A cross sectionalstudy was conducted in 64 patients with acute myocardial infarction (AMI) and 55 non-AMI as control from February to September2007. The level of cardiac troponin I (cTnI) was measured and determined it diagnostic value at a various cut off level. The sensitivity,specificity, PPV and NPV of this assay were 91%, 91%, 92% and 89% at cut off level of 1,0 ng/ml (according to the kit), respectively.The cut off of cTnI were divided into five levels: 0.8, 1.0, 1.2, 1.5, and 2.0 with the area under curve were 0.923, 0.908, 0.912, and0.897, respectively. The sensitivity were 94%, 91%, 86%, 81% and 72%, respectively, the specificity were 91%, 91%, 96%, 98% and98%, respectively. This rapid diagnostic test is sensitive and specific to diagnose an acute coronary syndromes.

Prognostic value of low-level cardiac troponin-I elevations in patients without definite acute coronary syndromes

2004 ◽  
Vol 148 (5) ◽  
pp. 776-782 ◽  
Author(s):  
Michael X. Pham ◽  
Mary A. Whooley ◽  
G.Thomas Evans ◽  
Catherine Liu ◽  
Homeira Emadi ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Prognostic Value ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Low Level ◽  
Coronary Syndromes
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