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Troponin Sensitive Diagnosis

Richard Body
Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6-12 h to undergo serial biomarker testing. As less than one fifth of the patients undergoing investigation actually has an acute coronary syndrome (ACS), there is tremendous potential to reduce unnecessary hospital admissions. Recent advances in diagnostic technology have improved the efficiency of care pathways...
September 2018: Turkish Journal of Emergency Medicine
Manal Abd El Baky Mahmoud, Menat Allah Ali Shaaban, Ali Ali Ramzy
Objective: To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period. Subjects and methods: This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients' group); at 3 h and then at 6-9 h from admission time...
September 2018: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
Anoop S V Shah, Atul Anand, Fiona E Strachan, Amy V Ferry, Kuan Ken Lee, Andrew R Chapman, Dennis Sandeman, Catherine L Stables, Philip D Adamson, Jack P M Andrews, Mohamed S Anwar, John Hung, Alistair J Moss, Rachel O'Brien, Colin Berry, Iain Findlay, Simon Walker, Anne Cruickshank, Alan Reid, Alasdair Gray, Paul O Collinson, Fred S Apple, David A McAllister, Donogh Maguire, Keith A A Fox, David E Newby, Christopher Tuck, Ronald Harkess, Richard A Parker, Catriona Keerie, Christopher J Weir, Nicholas L Mills
BACKGROUND: High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome. METHODS: In this stepped-wedge, cluster-randomised controlled trial across ten secondary or tertiary care hospitals in Scotland, we evaluated the implementation of an hs-cTnI assay in consecutive patients who had been admitted to the hospitals' emergency departments with suspected acute coronary syndrome...
August 24, 2018: Lancet
Jasper Boeddinghaus, Thomas Nestelberger, Raphael Twerenbold, Johannes Tobias Neumann, Bertil Lindahl, Evangelos Giannitsis, Nils Arne Sörensen, Patrick Badertscher, Janina E Jann, Desiree Wussler, Christian Puelacher, Maria Rubini Giménez, Karin Wildi, Ivo Strebel, Jeanne Du Fay de Lavallaz, Farah Selman, Zaid Sabti, Nikola Kozhuharov, Eliska Potlukova, Katharina Rentsch, Òscar Miró, F Javier Martin-Sanchez, Beata Morawiec, Jiri Parenica, Jens Lohrmann, Wanda Kloos, Andreas Buser, Nicolas Geigy, Dagmar I Keller, Stefan Osswald, Tobias Reichlin, Dirk Westermann, Stefan Blankenberg, Christian Mueller
Aims: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. Methods and results: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists...
August 29, 2018: European Heart Journal
M T Demir, A Baydin, R Amanvermez, A K Erenler, M Güzel, O Yücel
INTRODUCTION: In this study, our aim was to evaluate clinical utilities of Pentraxin 3 (PTX3) and Ischemia-modified Albumin (IMA) in diagnosis of acute coronary syndrome (ACS) and compare these two biomarkers with a conventional diagnostic marker, cardiac troponin I (cTnI). MATERIALS AND METHODS: Sixty adult patients with ACS diagnosis were involved into this prospective study. Additionally, 20 healthy subjects were determined as control group (Group IV). Patients were divided into 3 groups as follows: Patients with Acute Myocardial Infarction (STEMI Group, n=20, Group I), patients without ST elevation but with elevated cTnI levels (NSTEMI Group, n=20, Group II), and patients with unstable angina pectoris (USAP Group, n=20, Group III)...
2018: Bratislavské Lekárske Listy
Jan M Leerink, Simone J Verkleij, Elizabeth A M Feijen, Annelies M C Mavinkurve-Groothuis, Milanthy S Pourier, Kaisa Ylänen, Wim J E Tissing, Marloes Louwerens, Marry M van den Heuvel, Eline van Dulmen-den Broeder, Andrica C H de Vries, Cecile M Ronckers, Heleen J H van der Pal, Livia Kapusta, Jacqueline Loonen, Louise Bellersen, Yigal M Pinto, Leontien C M Kremer, Wouter E M Kok
OBJECTIVE: To systematically review the literature and assess the diagnostic value of biomarkers in detection of late-onset left ventricular (LV) dysfunction in childhood cancer survivors (CCS) treated with anthracyclines. METHODS: We systematically searched the literature for studies that evaluated the use of biomarkers for detection of LV dysfunction in CCS treated with anthracyclines more than 1 year since childhood cancer diagnosis. LV dysfunction definitions were accepted as an ejection fraction <50% or <55% and/or a fractional shortening <28%, <29% or <30%...
August 29, 2018: Heart: Official Journal of the British Cardiac Society
Thomas Reinhold, Evangelos Giannitsis, Martin Möckel, Lutz Frankenstein, Mehrshad Vafaie, Jörn O Vollert, Anna Slagman
BACKGROUND: Symptoms indicating acute coronary syndrome are commonly seen in emergency rooms, but only 10% of patients are actually diagnosed with acute myocardial infarction (AMI). The Guidelines for the diagnosis of patients with suspected AMI include either multiple testing of cardiac troponin (cTN) or a single combined test of cTN and copeptin, which facilitates earlier diagnosis or exclusion of AMI. The aim of the present analysis was to investigate the impact of combined copeptin/cTN testing on health care resource consumption and related costs both during and after initial hospital treatment...
2018: PloS One
Richard M Nowak, Chaun M Gandolfo, Gordon Jacobsen, Robert H Christenson, Michele Moyer, Michael Hudson, James McCord
STUDY OBJECTIVE: We determine how well a new Food and Drug Administration-approved single cardiac troponin T (cTnT) Generation 5 baseline measurement below the level of quantification (6 ng/L) and a novel study-derived baseline and 30-minute cTnT Generation 5 algorithm might adequately exclude acute myocardial infarction in patients with suspected acute coronary syndrome in a US emergency department (ED). METHODS: Patients presenting with any symptoms suspicious for acute coronary syndrome were enrolled at a single US ED...
August 14, 2018: Annals of Emergency Medicine
Douglas Y Mah, Ashwin Prakash, Diego Porras, Francis Fynn-Thompson, Elizabeth S DeWitt, Puja Banka
BACKGROUND: A child with an epicardial pacemaker presented with sudden death at our institution, secondary to coronary artery compression. This case prompted enhanced surveillance of all patients with epicardial pacing or defibrillation systems. OBJECTIVE: The purpose of this study was to determine the incidence of coronary artery compression and the diagnostic yield of catheter angiography (CA) and computed tomography (CT). METHODS: All patients with epicardial leads who underwent CA or cine CT were retrospectively reviewed...
August 11, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Raphael Twerenbold, Johannes Tobias Neumann, Nils Arne Sörensen, Francisco Ojeda, Mahir Karakas, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Maria Rubini Giménez, Christian Puelacher, Karin Wildi, Nikola Kozhuharov, Dominik Breitenbuecher, Ewelina Biskup, Jeanne du Fay de Lavallaz, Dayana Flores, Desiree Wussler, Òscar Miró, F Javier Martín Sánchez, Beata Morawiec, Jiri Parenica, Nicolas Geigy, Dagmar I Keller, Tanja Zeller, Tobias Reichlin, Stefan Blankenberg, Dirk Westermann, Christian Mueller
BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI...
August 7, 2018: Journal of the American College of Cardiology
Alma M A Mingels, Dorien M Kimenai
Biomarkers play an important role in the clinical management of cardiac care. In particular, cardiac troponins (cTn) and natriuretic peptides are the cornerstones for the diagnosis of acute myocardial infarction (AMI) and for the diagnosis of heart failure (HF), respectively. Current guidelines do not make a distinction between women and men. However, the commonly used "one size fits all" algorithms are topic of debate to improve assessment of prognosis, particularly in women. Due to the high-sensitivity assays (hs-cTn), lower cTn levels (and 99th percentile upper reference limits) were observed in women as compared with men...
2018: Advances in Experimental Medicine and Biology
Alireza Nezami, Sadegh Dehghani, Rahim Nosrati, Negar Eskandari, Seyed Mohammad Taghdisi, Gholamreza Karimi
Cardiovascular diseases (CVDs) are the most frequent mortality cause in many countries. The acute myocardial infraction (AMI) is one of the most common types of CVDs. Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) as predominant cardiac infarction biomarkers considered as "gold standard" for diagnosis of acute myocardial infraction (AMI). The restrictions of traditional methods have encouraged the development of highly sensitive and specific methods for cTnI and cTnT detection. The rapid, early, reliable, and cost-effective diagnosis of CVDs not only helps with patient survival, but also save cost and time to prosperous prognosis...
September 10, 2018: Journal of Pharmaceutical and Biomedical Analysis
Nurgul K Bakirhan, Goksu Ozcelikay, Sibel A Ozkan
Cardiovascular disease is the most reason for deaths in all over the world. Hence, biomarkers of cardiovascular diseases are very crucial for diagnosis and management process. Biomarker detection demand is opened the important way in biosensor development field. Rapid, cheap, portable, precise, selective and sensitive biomarker sensing devices are needed at this point to detect and predict disease. A cardiac biomarker can be orderable as C-reactive protein, troponin I or T, myoglobin, tumor necrosis factor alpha, interleukin-6, interleukin-1, lipoprotein-associated phospholipase, low-density lipoprotein and myeloperoxidase...
September 10, 2018: Journal of Pharmaceutical and Biomedical Analysis
N Aroonyadet, W Jeamsaksiri, A Wisitsoraat, A Tuantranont
We report a scalable, uniform, and sensitive top-down fabricated indium oxide (In2 O3 ) nanoribbon biosensor platform with integrated on-chip gate electrodes using two photolithographic masks. The purpose of this on-chip gate electrode is to control the operational point of the sensor during biomolecular detection replacing the cumbersome external Ag/AgCl electrode. It exhibits excellent capability in gating transistors in an aqueous condition and high stability during the sensing experiment, which is similar to the Ag/AgCl electrode...
October 5, 2018: Nanotechnology
Yi-Heng Li, Yu-Chen Wang, Yi-Chih Wang, Ju-Chi Liu, Cheng-Han Lee, Chun-Chi Chen, I-Chang Hsieh, Feng-You Kuo, Wei-Chun Huang, Shih-Hsien Sung, Chiung-Zuan Chiu, Jung-Cheng Hsu, Shu-Long Jen, Juey-Jen Hwang, Jiunn-Lee Lin
In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment...
September 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Camille Chenevier-Gobeaux, Louis Deweerdt, Anne-Valérie Cantero, Bertrand Renaud, Bruno Desmaizières, Sandrine Charpentier, Aline Leroy, Emmanuelle Adelaïde, Delphine Collin-Chavagnac, Eric Bonnefoy-Cudraz, Laurence Estepa, Akli Chekroune, Sylvie Basco, Stéphane Andrieu, Stéphane Bourgeois, Marie-Agnès Costa, Christine Vallejo, Tiphaine Robert, Siham Ouahabi, Bruno Baudin, Benedicte Beneteau-Burnat, Anne-Marie Gorce-Dupuy, Patrick Ray, Claire Gast, Monique Dehoux, Guillaume Lefèvre
Objectives: We aimed to compare the use of nine different cardiac troponin (cTn) assays (2 cTnT and 7 cTnI) for the diagnosis of NSTEMI in a single multi-centre population. Design and methods: One hundred and fifty-eight patients were included (mean age 60 years, SD 17 years), including 23 patients (14%) with NSTEMI. Results: The analytical comparison highlighted a large heterogeneity of cTn assays, as reflected by percentages of patients with detectable cTn, correlation coefficients, Passing-Bablok comparisons and concordance coefficients...
July 2018: Practical Laboratory Medicine
Hyungoo Shin, Bo-Hyoung Jang, Tae Ho Lim, Juncheol Lee, Wonhee Kim, Youngsuk Cho, Chiwon Ahn, Kyu-Sun Choi
INTRODUCTION: This study aimed to determine the diagnostic accuracy of adding copeptin to cardiac troponin (cTn) on admission to the emergency department (ED) for non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone. MATERIALS AND METHODS: A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed (search date: April 13, 2018). Primary studies were included if they accurately reported on patients with symptoms suggestive of acute myocardial infarction and measured both cTn alone and cTn with copeptin upon admission to the ED...
2018: PloS One
Thomas Mueller, Margot Egger, Evi Peer, Benjamin Dieplinger
BACKGROUND: In Europe, clinicians use so called high-sensitivity assays for the measurement of cardiac troponin I and T (i.e., hs-cTnI and hs-cTnT assays, also termed 5th generation assays) since several years. We aimed at performing a head-to-head comparison of two 5th generation assays in "real life use". METHODS: We studied 3588 consecutive patients presenting to an emergency department. We used both, a hs-cTnI assay from Abbott and a hs-cTnT assay from Roche in clinical routine...
October 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
M Negahdary, M Behjati-Ardakani, N Sattarahmady, H Heli
Background: Acute myocardial infarction (MI) accounts for one third of deaths. Cardiac troponin I (TnI) is a reliable biomarker of cardiac muscle tissue injury and is employed in the early diagnosis of MI. Objective: In this study, a molecular method is introduced to early diagnosis of MI by rapid detection of TnI. Materials and Methods: The detection method was based on electrochemical aptasensing, being developed using different methods and evaluation steps...
June 2018: Journal of Biomedical Physics & Engineering
Jasper Boeddinghaus, Raphael Twerenbold, Thomas Nestelberger, Patrick Badertscher, Karin Wildi, Christian Puelacher, Jeanne du Fay de Lavallaz, Elif Keser, Maria Rubini Giménez, Desiree Wussler, Nikola Kozhuharov, Katharina Rentsch, Òscar Miró, F Javier Martin-Sanchez, Beata Morawiec, Sabrina Stefanelli, Nicolas Geigy, Dagmar I Keller, Tobias Reichlin, Christian Mueller
BACKGROUND: Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate the Siemens-hs-cTnI-Centaur assay and develop 0/1-h and 0/2-h algorithms. METHODS: We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis); second, using hs-cTnI (Abbott-Architect, secondary analysis) measurements in addition to the clinically applied (hs)-cTn...
September 2018: Clinical Chemistry
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