National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: Analytical Issues for Biochemical Markers of Acute Coronary Syndromes

Apple, Fred S.; Jesse, Robert L.; Newby, L. Kristin; Cannon, Christopher P.; Francis, Gary S.; Morrow, David A.; Ravkilde, Jan; Storrow, Alan B.; Tang, W.H. Wilson; Christenson, Robert H.; Jaffe, Allan S.; Mair, Johannes; Ordóñez-Llanos, Jordi; Pagani, F.; Panteghini, Mauro; Tate, Jillian R.; Wu, Alan H.B.

doi:10.1373/clinchem.2006.084715

Cited by 195 publications

(81 citation statements)

References 31 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,16,36,37 suggest that the enigmatic modifications that define IMA correspond mainly to an increase in the number of fatty acid molecules bound to otherwise normal albumin, although contributions from acidosis or disturbed redox balance as suggested by others 14 cannot be excluded as further contributing factors and require further study. This would mean that "IMA" is strictly speaking neither a marker for ischemia nor oxidative stress, but a proxy for FFA levels.…”

Section: Discussionmentioning

confidence: 97%

“…Such conditions include obesity, diabetes, demanding aerobic physical exercise, prolonged fasting, and indeed other types of ischemia -a compilation that parallels the list of conditions in which elevated levels of IMA have been observed. 3,4,9,10 Interestingly, the characteristics of a nickel-albumin binding assay were described recently. 38 The primary 23 and under the test conditions, which involve an excess of Ni 2+ over albumin, the fatty-acid-sensitive site A will play a significant role in overall binding.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] IMA, as measured by the Albumin-Cobalt-Binding assay (ACB assay 5 ), is the only FDAapproved early biomarker for myocardial ischemia, 3 a contributing factor to acute coronary syndrome that may lead on to a heart attack. Plasma from ischemic patients displays reduced Co 2+ -binding ability compared to healthy controls; 6 this can be detected colorimetrically via complex formation between Co 2+ and dithiothreitol (DTT).…”

Section: Introductionmentioning

confidence: 99%

“…3,8 Accordingly, increased IMA values have been detected in a plethora of other conditions including fatty liver, cancer, infections, renal disease, preeclampsia, diabetes, stroke, and even sustained exercise. [2][3][4][8][9][10] Hence, several recent studies have questioned the usefulness of the ACB assay. 11,12 Despite over 70 studies involving over 15,000 patients, no conclusive explanation for the performance characteristics of the ACB assay has been offered, hampering efforts to improve its prognostic and/or diagnostic value.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Allosteric Inhibition of Cobalt Binding to Albumin by Fatty Acids: Implications for the Detection of Myocardial Ischemia

et al. 2012

View full text Add to dashboard Cite

Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes the work of researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Publisher's statement:This document is the Accepted Manuscript version of a Published Work that appeared in the final form in Journal of Medicinal Chemistry, © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work http://dx.doi.org/10.1021/jm3003137 A note on versions: The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Allosteric Inhibition of Cobalt Binding to Albumin by Fatty Acids: Implications for the Detection of Myocardial Ischemia

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Both strategies use a two-step process, which provides two potential opportunities to rule out AMI and hence to discharge patients within the 4-hour window specified in the scope for this assessment. This potential is conditional upon the achievement of short (< 1 hour) turnaround times for hs-cTn testing, as recommended by the joint National Academy of Clinical Biochemistry and IFCC guidelines on Tn testing 101 and in line with clinical opinion; a study of 1355 ED physicians in the USA indicated that 75% believed that the results of Tn testing should be available to them within 45 minutes. 102 The initial step for both the Abbott ARCHITECT hs-cTnI optimal strategy and Roche Elecsys hs-cTnT optimal strategy was based on the use of an LoB (3 ng/l) diagnostic threshold in a sample taken at presentation and was selected for optimal rule-out potential (low LR-), regardless of poor rule-in performance.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis

Westwood

Asselt

Ramaekers

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundEarly diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnecessary hospital admissions and anxiety.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of hs-cTn assays for the early (within 4 hours of presentation) rule-out of AMI in adults with acute chest pain.MethodsSixteen databases, including MEDLINE and EMBASE, research registers and conference proceedings, were searched to October 2013. Study quality was assessed using QUADAS-2. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies, otherwise random-effects logistic regression was used. The health-economic analysis considered the long-term costs and quality-adjusted life-years (QALYs) associated with different troponin (Tn) testing methods. The de novo model consisted of a decision tree and Markov model. A lifetime time horizon (60 years) was used.ResultsEighteen studies were included in the clinical effectiveness review. The optimum strategy, based on the Roche assay, used a limit of blank (LoB) threshold in a presentation sample to rule out AMI [negative likelihood ratio (LR–) 0.10, 95% confidence interval (CI) 0.05 to 0.18]. Patients testing positive could then have a further test at 2 hours; a result above the 99th centile on either sample and a delta (Δ) of ≥ 20% has some potential for ruling in an AMI [positive likelihood ratio (LR+) 8.42, 95% CI 6.11 to 11.60], whereas a result below the 99th centile on both samples and a Δ of < 20% can be used to rule out an AMI (LR– 0.04, 95% CI 0.02 to 0.10). The optimum strategy, based on the Abbott assay, used a limit of detection (LoD) threshold in a presentation sample to rule out AMI (LR– 0.01, 95% CI 0.00 to 0.08). Patients testing positive could then have a further test at 3 hours; a result above the 99th centile on this sample has some potential for ruling in an AMI (LR+ 10.16, 95% CI 8.38 to 12.31), whereas a result below the 99th centile can be used to rule out an AMI (LR– 0.02, 95% CI 0.01 to 0.05). In the base-case analysis, standard Tn testing was both most effective and most costly. Strategies considered cost-effective depending upon incremental cost-effectiveness ratio thresholds were Abbott 99th centile (thresholds of < £6597), Beckman 99th centile (thresholds between £6597 and £30,042), Abbott optimal strategy (LoD threshold at presentation, followed by 99th centile threshold at 3 hours) (thresholds between £30,042 and £103,194) and the standard Tn test (thresholds over £103,194). The Roche 99th centile and the Roche optimal strategy [LoB threshold at presentation followed by 99th centile threshold and/or Δ20% (compared with presentation test) at 1–3 hours] were extendedly dominated in this analysis.ConclusionsThere is some evidence to suggest that hs-CTn testing may provide an effective and cost-effective approach to early rule-out of AMI. Further research is needed to clarify optimal diagnostic thresholds and testing strategies.Study registrationThis study is registered as PROSPERO CRD42013005939.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Association of Long-term Change in N-Terminal Pro–B-Type Natriuretic Peptide With Incident Heart Failure and Death

et al. 2023

View full text Add to dashboard Cite

ImportanceMost studies, especially in primary prevention patients, have evaluated N-terminal B-type natriuretic peptide (NT-proBNP) at one time point. Evaluation of change in NT-proBNP may improve risk stratification for incident cardiovascular events.ObjectiveTo assess the association between change in NT-proBNP and risk for incident heart failure (HF) and death.Design, Setting, and ParticipantsParticipants were recruited from 4 US communities enrolled in the Atherosclerosis Risk in Community (ARIC) study. Individuals who attended ARIC visits 2 and 4 (approximately 6 years apart) with measurements of NT-proBNP and without prevalent HF were included. Assays of NT-proBNP were conducted between 2011 and 2013, and analysis took place between July 2021 and October 2022.ExposuresThe primary exposure variable was NT-proBNP change between visits 2 and 4, modeled as change categories (&lt;125 pg/mL or ≥125 pg/mL) and as percent change.Main Outcomes and MeasuresThe primary outcome measures were incident HF hospitalization and all-cause death. The association between changes in cardiovascular risk factors with change in NT-proBNP was further assessed.ResultsA total of 9776 individuals (mean [SD] age, 57.1 [5.7] years at visit 2; 5523 [56.5%] women) were included in the study. Compared with participants with NT-proBNP level less than 125 pg/mL at both visits, participants with NT-proBNP level of 125 pg/mL or higher at both visits had an increase in incident HF (adjusted hazard ratio [HR], 2.40 [95% CI, 2.00-2.88]) and mortality risk (HR, 1.68 [95% CI, 1.47-1.91). Participants with NT-proBNP levels of 125 pg/mL or higher at visit 2 and less than 125 pg/mL at visit 4 had similar risk for HF and death (HR, 1.01 [95% CI, 0.71-1.43]; HR, 0.79 [95% CI, 0.61-1.01]) compared with the group with NT-proBNP levels of less than 125 pg/mL at both visits. The percent change in NT-proBNP was positively associated with HF and death (HR, 1.06 [95% CI, 1.02-1.10]; HR, 1.05 [95% CI, 1.03-1.08] per 1-SD increase, respectively). Change in systolic blood pressure, low-density lipoprotein cholesterol, triglyceride level, body mass index, and estimated glomerular filtration rate were significantly associated with change in NT-proBNP.Conclusions and RelevanceIn this study, 6-year change in NT-proBNP reflected dynamic change in risk for HF events and death among community-dwelling adults without prevalent clinical HF. These results support the utility of serial NT-proBNP measurements to improve risk stratification of patients with pre-HF.

show abstract

National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: Analytical Issues for Biochemical Markers of Acute Coronary Syndromes

Cited by 195 publications

References 31 publications

Allosteric Inhibition of Cobalt Binding to Albumin by Fatty Acids: Implications for the Detection of Myocardial Ischemia

Allosteric Inhibition of Cobalt Binding to Albumin by Fatty Acids: Implications for the Detection of Myocardial Ischemia

High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis

Association of Long-term Change in N-Terminal Pro–B-Type Natriuretic Peptide With Incident Heart Failure and Death

Contact Info

Product

Resources

About