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.
Apple FS, Smith SW, Pearce LA, Murakami MAM. Assessment of the multiple biomarker approach for diagnosis of myocardial infarction in patients presenting with symptoms suggestive of acute coronary syndrome. Clin Chem 2009; 55: 93-100.
Vuori J, Syrjala H, Vaananen H. Myoglobin: Carbonic Anhydrase III ratio: Highly specific and sensitive early indicator for myocardial damage in acute myocardial infarction. Clin Chem 1996; 42: 107-9.
Vuotikka P, Ylitalo K, Vuori J, Vänänen K, Kaukoranta P, Lepojärvi M, et al. Serum myoglobin/carbonic anhydrase III ratio in the diagnosis of perioperative myocardial infarction during coronary bypass surgery. Scand Cardiovasc J 2003; 37: 23-9.
Glatz JF, Van der Vusse GJ. Cellular fatty acid binding proteins. Their function and physiological significance. Prog Lipid Res 1996; 35: 243-82.
Aslan D, Sandberg S. Simple statistics in diagnostic tests. Journal of Medical Biochemistry 2006, 26: 309-13.
Okamoto F, Sohmiya K, Ohkaru Y, Kawamura K, Asayama K, Kiura H, et al. Human heart-type cytoplasmic fatty acid binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and CK-MB. Clin Chem Lab Med 2000; 38: 231-8.
Ishii J, Ozaki Y, Lu J, Kitagawa F, Kuno T, Nakano T, et al. Prognostic value of serum concentration of heart-type fatty acid binding protein relative to cardiac troponin T on admission in the early hours of acute coronary syndrome. Clin Chem 2005; 51: 1397-404.
O'Donoghue M, De Lemos JA, Morrow DA, Murphy SA, Buros J, Cannon C, et al. Prognostic utility of H-FABP in patients with acute coronary syndromes. Circulation 2006; 114: 550-7.
Zaninotto M, Mion MM, Novello E, Altinier S, Rocco S, Cacciavillani L, et al. Analytical evaluation of new heart-type fatty acid binding protein automated assay. Clin Chem Lab Med 2006; 44: 1383-5.
Zaninotto M, Mion MM, Novello E, Altinier S, Plebani M. New biochemical markers: from bench to bedside. Clin Chim Acta 2007; 381: 14-20.
Valle HA, Riesgo LG, Bel MS, Gonzalo FE, Sanchez MS, Oliva LI. Clinical assessment of heart-type fatty acid binding protein in early diagnosis of acute coronary syndrome. Eur J Emerg Med 2008; 15: 140-4.
Sawicki M, Odrowaz-Sypniewska G, Krintus M, Ostrowska-Nowak J, Pilaczynska-Cemel M, Budzbon D, et al. Evaluation of efficacy of heart-type fatty acid binding protein (H-FABP) for diagnosis of acute coronary syndromes. Diagn Lab 2008; 44: 459-65.