Daniel Omersa, Tanja Cufer, Robert Marcun and Mitja Lainscak
develop long-term cardiotoxicity, patients with early stage NSCLC with longer survival could. To answer this question, future studies exploring LVEF and biomarker changes and possible development of overt heart failure in those with preclinical cardiotoxicity in early stage NSCLC patients treated with platinum-based chemotherapy are necessary.
Despite its limitations, we think that this study is important, because it is the second study to evaluate cardiotoxicity in NSCLC patients treated with platinum-based chemotherapy. We were able to detect changes in cardiac
Basak Hanedan, Akin Kirbas, Emrullah Dorman, Ozkan Timurkan Mehmet, Mehmet Fatih Kandemir and Omer Alkan
The aim of this study was to evaluate the serum cardiac troponin I (cTnI) concentrations in weaned calves with moderate and severe bovine respiratory disease. Eighteen healthy weaned calves (group I), 18 weaned calves with moderate bovine respiratory disease (group II) and 18 weaned calves with severe bovine respiratory disease (group III) were included in the study. Clinical signs and severity of respiratory disease according to clinical index scores were determined. Blood cell counts and cardiac biomarkers, such as serum cTnI concentrations and creatine kinase-myocardial band (CK-MB), and lactate dehydrogenase (LDH) activities were determined in all groups. Temperature and respiratory and pulse rates were significantly increased in calves with moderate and severe bovine respiratory disease compared to healthy calves (P < 0.05). Serum cTnI concentrations and LDH activities were significantly increased in the calves with severe bovine respiratory disease compared to healthy calves and calves with moderate bovine respiratory disease (P < 0.05). A significant increase in white blood cell counts in calves with moderate and severe bovine respiratory disease and lymphopenia and neutrophilia in calves with severe bovine respiratory disease were also found. The study suggests that severe bovine respiratory disease causes increased serum cTnI concentrations in weaned calves.
Copeptin - is There a Role for Another Cardiac Biomarker?
The discovery and development of new biomarkers continues to be a promising field. Since cardiovascular disease remains the principal cause of death in the developed countries, this is the area in which novel biomarkers have been most extensively evaluated. Arginine vasopressin (AVP or antidiuretic hormone) is one of the key hormones in the human body involved in cardiovascular homeostasis. It has so far escaped introduction into the routine clinical laboratory due to technical difficulties and pre-analytical errors. Copeptin, the C-terminal part of the AVP precursor peptide, was found to be a stable and sensitive surrogate marker for AVP release. During the past years, copeptin measurement has been shown to be of interest in a variety of clinical indications, including cardiovascular diseases such as heart failure, myocardial infarction, and stroke. This review summarizes the recent progress in the diagnostic use of plasma copeptin in cardiovascular diseases.
Laboratory medicine and clinical medicine are co-dependent components of medicine. Laboratory medicine functions most effectively when focused through a clinical lens. Me dical practice as a whole undergoes change. New drugs, treatments and changes in management strategies are introduced. New techniques, new technologies and new tests are developed. These changes may be either clinically or laboratory initiated, and so their introduction requires dialogue and interaction between clinical and laboratory medicine specialists. Treatment monitoring is integral to laboratory medicine, varying from direct drug measurement to monitoring cholesterol levels in response to treatment. The current trend to »personalised medicine« is an extension of this process with the development of companion diagnostics. Technological innovation forms part of modern laboratory practice. Introduction of new technology both facilitates standard laboratory approaches and permits introduction of new tests and testing strategies previously confined to the research laboratory only. The revolution in cardiac biomarker testing has been largely a laboratory led change. Flexibility in service provision in response to changing clinical practice or evolving technology provides a significant laboratory management challenge in the light of increasing expectations, shifts in population demographics and constraint in resource availability. Laboratory medicine practitioners are adept at meeting these challenges. One thing remains constant, that there will be a constant need laboratory medicine to meet the challenges of novel clinical challenges from infectious diseases to medical conditions developing from lifestyle and longevity.
Giuseppe Lippi, Ruggero Buonocore, Michele Mitaritonno and Gianfranco Cervellin
Background: We performed a retrospective case-control study to assess the values of cardiac troponin I (cTnI) in a large number of patients admitted to the emergency department (ED) with different types of trauma.
Methods: The study population consisted of all patients aged 18 years or older admitted to the local ED with all types of traumas over a 1-year period. Results of cTnI were compared with those of 125 consecutive blood donors and 25 non-cardiac chest pain ED patients.
Results: The final study population consisted of 380 trauma patients, 10 with isolated abdominal trauma, 99 with isolated trauma of the limbs, 49 with isolated chest trauma, 145 with isolated head trauma and 77 with polytrauma. The concentration of cTnI did not differ among the three study populations, but the frequency of measurable values was substantially higher in patients with trauma (63%) than in blood donors and non-cardiac chest pain ED patients (both 20%). The frequency of cTnI values above the 99th percentile of the reference range was significantly higher in trauma patients (20%) than in blood donors (0%) and noncardiac chest pain ED patients (8%). Increased cTnI values were more frequent after head trauma (21%), chest trauma (27%) and polytrauma (29%) compared to patients with abdominal (0%) or limbs trauma (8%).
Conclusions: These results suggest that the measurement of cardiac troponin may be advisable to identify potential cardiac involvement in trauma patients, especially in those with polytrauma and head or chest trauma.
Danica Marković, Tatjana Jevtović-Stoimenov, Vladan Ćosić, Biljana Stošić, Vesna Dinić, Bojana Marković-Živković and Radmilo J. Janković
Background: Recent studies indicate that survivin (BIRC5) is sensitive to the existence of previous ischemic heart disease, since it is activated in the process of tissue repair and angiogenesis. The aim of this study was to determine the potential of survivin (BIRC5) as a new cardiac biomarker in the preoperative assessment of cardiovascular risk in comparison with clinically accepted cardiac biomarkers and one of the relevant clinical risk scores.
Methods: We included 79 patients, female (41) and male (38), with the mean age of 71.35±6.89. Inclusion criteria: extensive non-cardiac surgery, general anesthesia, age >55 and at least one of the selected cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking and positive family history). Exclusion criteria: emergency surgical procedures and inability to understand and sign an informed consent. Blood sampling was performed 7 days prior surgery and levels of survivin (BIRC5), hsCRP and H-FABP were measured.
Results: Revised Lee score was assessed based on data found in patients’ history. Levels of survivin (BIRC5) were higher in deceased patients (P<0.05). It showed AUC=0.807 (95% CI, P<0.0005, 0.698–0.917), greater than both H-FABP and revised Lee index, and it increases the mortality prediction when used together with both biomarkers and revised Lee score. The determined cut-off value was 4 pg/mL and 92.86% of deceased patients had an increased level of survivin (BIRC5), (P=0.005).
Conclusions: Survivin (BIRC5) is a potential cardiac biomarker even in elderly patients without tumor, but it cannot be used independently. Further studies with a greater number of patients are needed.
Grazyna Sypniewska, Marcin Sawicki, Magdalena Krintus, Marek Kozinski and Jacek Kubica
The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary Syndromes
Serum troponin is the best biomarker for the diagnosis of acute coronary syndrome, but it takes considerable time before a definitive diagnosis is available. The purpose of this study was to evaluate whether a multimarker approach, using the biochip cardiac array, would facilitate the early diagnosis. Serum biomarkers were determined on admission (≤6 hrs) and after 6 hours in 42 patients suspected for ACS. Cardiac troponin I was measured by a sensitive assay (STATcTnI) and cardiac markers (H-FABP, myoglobin, cTnI, CK-MB mass, carbonic anhydrase III) were assayed with the use of Biochip Array Technology. STATcTnI concentrations, within the first 6 hours, were elevated >99th percentile for the reference population in 83.3% of subjects, but none reached the cut-off for AMI. On admission H-FABP was the only marker with 90.5% sensitivity in all ACS cases and 100% sensitivity in STEMI/NSTEMI patients. The sensitivity of myoglobin at presentation was 71.4% in ACS, however, combined sensitivity of myoglobin and H-FABP reached 95.2%. Lowering the cut-off for cTnI allowed early diagnosis (≤6 hrs) in only 26.2% of ACS patients and 95.2% after the next 6 hours. In unstable angina the cardiac panel was not sufficiently accurate for early risk stratification. In conclusion, testing for both markers, H-FABP and sensitive cardiac troponin, available with the cardiac array may facilitate the early detection of myocardial injury in clinical practice.
Gian Luca Salvagno, Davide Giavarina, Moira Meneghello, Roberta Musa, Rosalia Aloe, Giorgio Da Rin and Giuseppe Lippi
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Lukas Piliponis, Gintarė Neverauskaitė-Piliponienė, Monika Kazlauskaitė, Pavel Kačnov, Sigita Glaveckaitė, Jūratė Barysienė and Saulius Ročka
Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required.
An outbreak of trichinellosis affecting 13 individuals, of whom 8 with severe form presented as myocarditis, occurred in the village of Subotinac near the town of Aleksinac in Serbia. The source of this epidemic was smoked pork from a domestic pig that had not undergone meat inspection procedures. The most striking clinical features among all the 13 patients were muscular pain (84.6%), malaise (69.2%), upper eyelid edema (61.5%), and difficulty in chewing (53.9%). These symptoms and signs were associated with significant elevations of creatine phosphokinase and lactate dehydrogenase levels. As high as 61.5% of the patients with trichinellosis were diagnosed with myocarditis (determined by means of electrocardiography, echocardiography, troponin I and creatine kinase-MB measurements). The patients had Trichinella-specific IgG antibodies in an enzyme-linked immunosorbent assay and positive indirect immunofluorescence test results. Patients seemed to respond well to treatment with mebendazole. Corticosteroid therapy was administered to patients with myocarditis. Since high percentage of our patients presented with myocarditis, an infectious diseases specialist should always keep in mind doing cardiac biomarkers analyses, echocardiography and electrocardiography.