Clinica chimica acta; international journal of clinical chemistry
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There are several issues driving the rapid advancement in diagnostic technology for acute cardiac syndromes. First is safety, primarily the need to improve sensitivity in lower-risk patients presenting with symptoms suggestive of ischemia; second is fiscal, especially to reduce the cost for the evaluation of low-risk chest pain patients; and third is therapeutic, including the ability to effectively risk-stratify patients who may be candidates for more aggressive therapy.
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This review describes the pathophysiological and histopathological rationale for using the cardiac isoforms of troponin T and troponin I in congestive heart failure (CHF). It also focuses on the potential clinical usefulness of new generation highly sensitive and specific cardiac troponin assays with respect to histological monitoring, risk stratification and therapeutic follow-up of patients with CHF. The availability of more powerful analytical tools for these highly specific markers of myocardial injury offers a unique opportunity to expand the field of their application and to explore new disease processes. Because cardiac troponin T and cardiac troponin I provide useful clinical information unavailable through other diagnostic techniques, they appear as promising biochemical markers in patients with CHF.
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Point-of-care (POC) or "near-patient" testing allows diagnostic assays to be performed in locations such as the emergency department or intensive care unit where treatment decisions are made and care is delivered based on the results of these assays. Presently, there exist POC immunoassays for several cardiac markers including creatine kinase MB (CK-MB), myoglobin, troponin I, and troponin T that yield qualitative and quantitative results comparable to traditional central lab assays. In the evaluation of emergency room patients with chest pain, POC cardiac markers may improve triage and clinical outcomes. ⋯ Along with POC troponin I assays, these tests provide more sensitive identification of myocardial injury and valuable prognostic information. Prior studies of POC cardiac marker assays have not addressed whether POC testing affects patient outcome or process of care. In situations in which caregivers base triage, treatment and monitoring decisions on time-sensitive diagnostic results, POC tests linked with improved triage and treatment strategies may improve resource utilization and clinical outcomes.
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The emergency department (ED) evaluation of patients with potential acute coronary syndromes (ACS) has traditionally included initial cardiac marker testing for suspected acute myocardial infarction (AMI). While ED management decisions for patients with ACS have largely been based on history, physical examination, and a presenting 12-lead electrocardiogram (ECG), there is ample evidence that markers impact treatment decisions and provide risk stratification. Newer, more sensitive markers of myocardial necrosis have blurred the distinction between patients with and without classically defined AMI, and have focused attention on the continuum of ACS from angina to transmural Q-wave MI. ⋯ Such centers use serial cardiac marker testing as a mainstay for evaluation and risk stratification. Cost issues have driven many diagnostic patient evaluations from the inpatient setting to such ED observation units. As this becomes more common for low- to moderate-risk patients with chest pain, serial assessment of cardiac markers, and their interpretation by emergency physicians, will become essential.
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This study was designed to clarify the effects of pentoxifylline (PTX) and N-acetylcysteine (NAC) on hepatic reperfusion injury in rats. Rats were pretreated with NAC, or PTX, or combination of the drugs. In each rat, liver was isolated after twenty minutes reperfusion following thirty minutes ischemia. ⋯ SOD activities were higher in the ischemia/reperfusion (P < 0.01) and the PTX-treated (P < 0.01) and the NAC-PTX-treated groups (P < 0.01 ). In conclusion, short-term liver ischemia/reperfusion diminished GSH, increased MDA and induced some antioxidant enzymes. While we could not find any useful effects with PTX as we expected, our findings indicate that NAC might be useful to prevent tissue damage in hepatic ischemia/reperfusion injury.