Clinical biochemistry
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Clinical biochemistry · Mar 2015
ReviewEffectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review.
This article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. ⋯ The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).
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Clinical biochemistry · Mar 2015
ReviewHow acute changes in cardiac troponin concentrations help to handle the challenges posed by troponin elevations in non-ACS-patients.
Cardiac troponins (cTn) I and T are organ-specific, but not disease specific biomarkers. Although acute myocardial infarction (AMI) is the most important cause of cTn elevation, other cardiac disorders as well as primarily noncardiac disorders with cardiac involvement often are also associated with cardiomyocyte injury. Levels of cTn should be interpreted as quantitative markers of cardiomyocyte injury with the likelihood of AMI increasing with the level of cTn. ⋯ Two caveats apply to the diagnostic use of cTn changes. First, patients with AMI may show no or only a minimal change when assessed around the peak of cTn release. Second, in addition to AMI, several other acute cardiac conditions including tachyarrhythmias, myocarditis, hypertensive crisis, and Takotsubo cardiomyopathy also may present with substantial cTn changes.
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Clinical biochemistry · Mar 2015
ReviewUse and interpretation of high sensitivity cardiac troponins in patients with chronic kidney disease with and without acute myocardial infarction.
It is well known that the population with chronic kidney disease (CKD) is at greater risk for cardiovascular disease and death than the general population. The use and interpretation of high sensitivity cardiac troponin (hs-cTn) assays have been particularly challenging in these patients with the majority having elevated levels at baseline. The diagnostic accuracy of acute myocardial infarction (AMI) may be decreased in patients with CKD when using these newer troponins. ⋯ The purpose of the review is to evaluate hs-cTn in patients with CKD for the diagnosis of AMI and for the prognostic significance of elevated levels in CKD patients without AMI. Although the underlying etiology of persistently elevated cTn in the CKD population remains unclear, the review will also evaluate studies attempting to explain whether the source of cTn is from increased cardiac production versus decreased renal clearance. Further longitudinal studies are required in order to bridge the gap between the prognostic importance of elevated cTn and clinical management to prevent symptomatic cardiac disease.
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Clinical biochemistry · Mar 2015
Multicenter Study Observational StudyCombining presentation high-sensitivity cardiac troponin I and glucose measurements to rule-out an acute myocardial infarction in patients presenting to emergency department with chest pain.
The use of high sensitivity troponin (hs-Tn) may enable early rule out of acute myocardial infarction (AMI) for patients presenting to the emergency department (ED) with chest pain. This study evaluated two approaches to the early rule out of AMI; a combination of a presentation hs-Tn <4ng/L and normal glucose at presentation (dual testing) and a presentation hs-Tn troponin below the limit of detection (LoD). ⋯ The dual testing and LoD approach identified all patients with index AMI and could be used to reduce the proportion of patients requiring lengthy assessment and inpatient admission. Further investigation is still required to rule out unstable angina pectoris in patients identified as low risk.
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Clinical biochemistry · Mar 2015
ReviewIFCC educational materials on selected analytical and clinical applications of high sensitivity cardiac troponin assays.
In 2011, the IFCC Task Force on Clinical Applications of Cardiac Bio-Markers (TF-CB) was formed, with the purpose of providing evidence based educational materials to assist all biomarker users, i.e. laboratorians, clinicians, researchers, in-vitro diagnostics and regulatory agencies, in better understanding important analytical and clinical aspects of established and novel cardiac biomarkers for use in clinical practice and research. The goal of the task force was to promulgate the same information conjointly through the in vitro diagnostic industry to the laboratory, emergency department and cardiologists. The initial undertaking of the TF-CB, which is comprised of laboratory medicine scientists, emergency medicine physicians and cardiologists, was to address two key issues pertaining to implementing high-sensitivity cardiac troponin (hs-cTn) assays in clinical practice: the 99th percentile upper reference limit (URL) and calculating serial change values in accord with the Universal Definition of AMI. The highlights of both concepts from IFCC statements are described.