The exciting story of cardiac biomarkers: From retrospective detection to gold diagnostic standard for acute myocardial infarction and more

Dolci, Alberto; Panteghini, Mauro

doi:10.1016/j.cca.2006.02.042

Cited by 97 publications

(69 citation statements)

References 72 publications

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“…AST is found in the liver, heart, skeletal muscles, brain and kidneys. Due to its lack of specificity to the cardiac tissue it is no longer used for the diagnosis of AMI (12,13). In the year 1959, the total CK level was assessed for AMI, as it was a good indicator of skeletal muscle injury (14).…”

Section: Biomarkers Of Myocardial Infarctionmentioning

confidence: 99%

Diagnostic markers of acute myocardial infarction

2015

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Abstract. Acute myocardial infarction (AMI) is a major cause of morbidity and mortality worldwide. The highest risk of fatality occurs within the initial hours of onset of AMI. Thus, early diagnosis of cardiac ischemia is critical for the effective management of patients with AMI. Improper diagnosis of patients with chest pain often leads to inappropriate admission of patients without AMI and vice versa. In addition to clinical history, physical examination, accurate electrocardiogram findings and assessment of cardiac biomarkers have an important role in the early diagnosis of acute ischemia. The present review discusses in detail the various cardiac biomarkers released during the event of an AMI.

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Section: Biomarkers Of Myocardial Infarctionmentioning

confidence: 99%

Diagnostic markers of acute myocardial infarction

2015

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“…From its initial advent, cTn, although providing higher sensitivity for small injury and virtually absolute specificity for myocardial damage when compared with creatine kinase MB (CK-MB) isoenzyme, left some aspects open to discussion [29]. At that time, some authors already underlined that the cardiac specificity and sensitivity of cTn measurement could be a two-edged sword when this marker is used in clinical practice [30].…”

Section: : Increasing Ctn Positivity Ratesmentioning

confidence: 99%

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

Ferraro¹,

Panteghini

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The availability of so-called high-sensitivity troponin assays (hsTn) has scored a compelling goal for laboratory medicine, allowing the safe clinical application of international recommendations for the definition of acute myocardial infarction (AMI). However, the introduction of hsTn has not been welcomed by clinicians, claiming an increase in false-positive results. Here we critically trace back the steps following the introduction of hsTn by referring to the 5-year practical experience in our academic hospital and to suitable information available in the literature. In agreement with published data, we found that hsTn introduction was associated with an increased number of AMI diagnoses, whereas the test volume, the revascularization rate, and the proportion of cases with negative angiography findings remained virtually unchanged. Fast-track protocols for ruling out AMI have been further optimized to recommend sampling at presentation and after 3 h only. We focus on a cost-effective use of hsTn that can account for all clinical variables increasing the pre-test probability in order to ensure that tests are ordered only for patients at medium to high risk for acute coronary syndrome (ACS). To guide interpretation of results, hsTn typical release patterns suggestive for AMI should be identified by evaluating the significance of concentration changes. hsTn have markedly shortened the time to rule out or rule in AMI and has the potential to improve the prognostic assessment of critical patients in clinical contexts different from ACS.

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“…The potential effects of all drugs, currently used in ACS management, upon cTn values have not been studied adequately still. Use of high-sensitive (hs), new generation tests for cTn improves sensitivity and specificity (AUC from 0.95 to 0.96, depending on manufacturers) vs. standard assay (AUC 0.90; confidence interval 0.86 to 0.94) (27). Simultaneously, with the increase in test sensitivity, the possibility for FP cTn increases as well, and this fact, associated with a low index of individuality for cTn, indicates that population-based reference and cut-off values are less useful for interpreting cTn results than following serial changes in values in individual patients (28,29).…”

Section: What Are the Causes Of Analytic No Actual Myocardial Damagementioning

confidence: 99%

False Positive Troponin – A True Problem

Koraćević¹,

Ćosić²,

Stojanović³

2013

Journal of Medical Biochemistry

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Summary Cardiac troponins have a crucial role in diagnosing acute myocardial infarction, but have been considered by some authors to have a high false positive rate. Such opinions may decrease the confidence in troponin with important clinical consequences. The aim of the paper is to analyze three different meanings of the phrase »false positive troponin«: A) analytic (technical) false positive, with no real myocardial damage; B) false positive considering AMI: cardiac injury is present, but there is no AMI; C) false positive considering CAD: there is myocardial damage, but no CAD. The most frequent and the most important source of misunderstanding is the confusion between aspects A) and B). Namely, there has been a relatively small percentage of false positive troponin elevations due to analytic reasons. On the contrary, there has been a re - latively large percentage of »false positive« results in patients with myocardial necrosis due to causes other than AMI; for them - instead of »FP troponin elevation« - another phrase ought to be used, e.g., »non-AMI troponin elevation « until the etiopathogenesis in an individual patient is recognized. The phrase »false positive troponin« should be restricted to the artificial increase in troponin due to preanalytic and analytic reasons. By doing so, we may decrease the degree of confusion about troponin and increase the confidence in this highly specific marker of myocardial injury. The possibility of an analytic false positive result should always be kept in mind when one interprets elevated troponin.

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The exciting story of cardiac biomarkers: From retrospective detection to gold diagnostic standard for acute myocardial infarction and more

Cited by 97 publications

References 72 publications

Diagnostic markers of acute myocardial infarction

Diagnostic markers of acute myocardial infarction

Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm

False Positive Troponin – A True Problem

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