A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

Straface, Angela L.; Myers, John; Kirchick, Howard J.; Blick, Kenneth E.

doi:10.1309/9ggnmurljwjd88w3

Cited by 43 publications

(46 citation statements)

References 33 publications

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“…248,249 The use of rate of change (delta value) for myoglobin has been claimed to improve diagnostic sensitivity. 250 The addition of delta value served only to reduce the specificity of myoglobin measurement without a concomitant increase in sensitivity. Sensitive troponin measurement alone appears superior to measurement of CK-MB and myoglobin.…”

Section: Role Of Conventional Biomarkers For Diagnosismentioning

confidence: 99%

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

Collinson

Gaze²,

Thokala³

et al. 2013

Health Technol Assess

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/22/16. The contractual start date was in August 2010. The draft report began editorial review in February 2012 and was accepted for publication in June 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by the NIHR Journals Library, produced by Prepress Projects Ltd, Perth, Scotland (www.prepress-projects.co.uk). Objectives: To test the diagnostic accuracy for detecting an acute myocardial infarction (AMI) using highly sensitive troponin assays and a range of new cardiac biomarkers of plaque destabilisation, myocardial ischaemia and necrosis; to test the prognostic accuracy for detecting adverse cardiac events using highly sensitive troponin assays and this range of new cardiac biomarkers; and to estimate the cost-effectiveness of using highly sensitive troponin assays or this range of new cardiac biomarkers instead of an admission and 10-to 12-hour troponin measurement. NIHR Journals LibraryDesign: Substudy of the point-of-care arm of the RATPAC (Randomised Assessment ...

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Section: Role Of Conventional Biomarkers For Diagnosismentioning

confidence: 99%

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

Collinson

Gaze²,

Thokala³

et al. 2013

Health Technol Assess

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“…The first methods for Myo determination in blood were all supported by immunoreactions, including radioimmunoassay [8,11,12], counterimmunoelectrophoresis [13] enzyme-immunoassay [8] chemiluminescent immunoassay [14] and latex agglutination immunoassay [15][16][17], later coupled to turbidimetric [18] or nephelometric [19,20] readings and to other solid support materials, such as polystyrene [20]. In subsequent years many attempts have been made to create suitable devices for POC applications [21,22]. They employ various transducer principles but keep the immunochemical background.…”

Section: Introductionmentioning

confidence: 99%

Novel biosensing device for point-of-care applications with plastic antibodies grown on Au-screen printed electrodes

Moreira

Dutra

Noronha

et al. 2013

Sensors and Actuators B: Chemical

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A gold screen printed electrode (Au-SPE) was modified by merging Molecular Imprinting and Self-Assembly Monolayer techniques for fast screening cardiac biomarkers in point-of-care (POC). For this purpose, Myoglobin (Myo) was selected as target analyte and its plastic antibody imprinted over a glutaraldehyde (Glu)/cysteamine (Cys) layer on the gold-surface. The imprinting effect was produced by growing a reticulated polymer of acrylamide (AAM) and N,N * -methylenebisacrylamide (NNMBA) around the Myo template, covalently attached to the biosensing surface. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) studies were carried out in all chemical modification steps to confirm the surface changes in the Au-SPE.The analytical features of the resulting biosensor were studied by different electrochemical techniques, including EIS, square wave voltammetry (SWV) and potentiometry. The limits of detection ranged from 0.13 to 8 µg/mL. Only potentiometry assays showed limits of detection including the cut-off Myo levels. Quantitative information was also produced for Myo concentrations ≥0.2 µg/mL. The linear response of the biosensing device showed an anionic slope of ∼70 mV per decade molar concentration up to 0.3 µg/mL. The interference of coexisting species was tested and good selectivity was observed. The biosensor was successfully applied to biological fluids.

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“…Our results suggest that the test is at least as capable of predicting HS as it is of detecting cardiac damage (36,45,53,60,61), which was the initial and primary manufactured purpose of the test. The high reproducibility and ease of this test supports its use in high-risk situations where trained medical personnel and specialized equipment may not be readily available or accessible (e.g., amateur athletics, remote military operations, construction sites, etc.).…”

Section: Perspectives and Significancementioning

confidence: 82%

Point-of-care cardiac troponin test accurately predicts heat stroke severity in rats

Audet

Quinn

Leon

2015

American Journal of Physiology-Regulatory, Integrative and Comp

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Audet GN, Quinn CM, Leon LR. Point-of-care cardiac troponin test accurately predicts heat stroke severity in rats. Am J Physiol Regul Integr Comp Physiol 309: R1264 -R1272, 2015. First published August 19, 2015; doi:10.1152/ajpregu.00286.2015.-Heat stroke (HS) remains a significant public health concern. Despite the substantial threat posed by HS, there is still no field or clinical test of HS severity. We suggested previously that circulating cardiac troponin (cTnI) could serve as a robust biomarker of HS severity after heating. In the present study, we hypothesized that (cTnI) point-of-care test (ctPOC) could be used to predict severity and organ damage at the onset of HS. Conscious male Fischer 344 rats (n ϭ 16) continuously monitored for heart rate (HR), blood pressure (BP), and core temperature (Tc) (radiotelemetry) were heated to maximum Tc (Tc,Max) of 41.9 Ϯ 0.1°C and recovered undisturbed for 24 h at an ambient temperature of 20°C. Blood samples were taken at Tc,Max and 24 h after heat via submandibular bleed and analyzed on ctPOC test. POC cTnI band intensity was ranked using a simple four-point scale via two blinded observers and compared with cTnI levels measured by a clinical blood analyzer. Blood was also analyzed for biomarkers of systemic organ damage. HS severity, as previously defined using HR, BP, and recovery Tc profile during heat exposure, correlated strongly with cTnI (R 2 ϭ 0.69) at Tc,Max. POC cTnI band intensity ranking accurately predicted cTnI levels (R 2 ϭ 0.64) and HS severity (R 2 ϭ 0.83). Five markers of systemic organ damage also correlated with ctPOC score (albumin, alanine aminotransferase, blood urea nitrogen, cholesterol, and total bilirubin; R 2 Ͼ 0.4). This suggests that cTnI POC tests can accurately determine HS severity and could serve as simple, portable, cost-effective HS field tests. field test; heat stroke; cardiac troponin; point of care; rat HEAT-RELATED ILLNESSES remain a substantial public health threat. Heat stroke (HS) is the most severe form of heat illness, typically presenting as a core temperature (T c ) of Ͼ40°C (104°F) accompanied by central nervous system (CNS) dysfunction, visceral organ failure, and cardiovascular damage (2,6,12,13,16,22,49,51,59). Heat-related illness is associated with considerable pathological variability, and both during heat stress and recovery there is a wide spectrum of physiological responses between individuals. This, in combination with the extremely complex systemic etiology of HS, has meant that testing for HS severity at any time point, but specifically early in recovery, has proven extremely challenging. Presently, there are no validated clinical or field-expedient tests capable of delineating severity during heat or acute recovery.We have shown in mice that the T c response during recovery, specifically the depth of post-HS hypothermia, is a marker of HS severity (39 -41). Hypothermia during recovery has been observed in clinical cases and documented in the most severe HS cases, including deaths (43). More recently, we es...

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A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

Cited by 43 publications

References 33 publications

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

Novel biosensing device for point-of-care applications with plastic antibodies grown on Au-screen printed electrodes

Point-of-care cardiac troponin test accurately predicts heat stroke severity in rats

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