By David A. Morrow
Within the 4 pages dedicated to a dialogue of myocardial infarction within the first version of Harrison’s ideas of inner medication, released in 1950, there has been no point out of use of the laboratory for administration of sufferers. Thirty years later, while the 1st variation of Braunwald’s middle sickness, A Textbook of Cardiovascular drugs used to be released, 2 out of the 1943 pages within the textual content contained a dialogue of the laboratory examinations in acute myocardial infarction. Our wisdom base of the multitude of the way that physicians can and may use the medical chemistry laboratory has multiplied dramatically in view that those vintage texts have been released. The nomenclature has replaced: phrases corresponding to “cardiac enzymes” have given strategy to “cardiac biomarkers. ” The variety of assays has expanded, and the working features of accessible assays are impr- ing at a fulfilling yet dizzying fee. We now use biomarkers to diagnose cardiovascular illnesses and in addition to border our remedy concepts. therefore, there's a transparent desire for a scholarly compilation of the state-of-the-art of cardiac biomarkers. Dr. David Morrow has expertly edited an authoritative e-book that solutions this desire. The 34 chapters in Cardiovascular Biomarkers: Pathophysiology and ailment Mana- ment have been written by means of a gaggle of people who're the world over famous notion leaders and specialists in scientific and laboratory medication.
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Sample text
Human heart-type cytoplasmic fatty acid–binding protein in serum and urine during hyperacute myocardial infarction. Int J Cardiol 1993;41:209–217. 68. Van Nieuwenhoven FA, Kleine AH, Wodzig WH, et al. Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid–binding protein. Circulation 1995;92:2848–2854. 69. Ishii J, Wang JH, Naruse H, et al. Serum concentrations of myoglobin vs human heart–type cytoplasmic fatty acid–binding protein in early detection of acute myocardial infarction.
The data are from the College of American Pathologists 2004 Proficiency Survey (20). Although each of the commercial assays demonstrates linearity between individual concentrations and the zero point (demonstrating minimal offset bias), there is substantial proportional bias between assays, as recognized by the slope of each line against an arbitrarily selected predicate assay. Using results of assays that produce the lowest and highest cTnI results (Triage and AxSYM, respectively), the slopes differ by a factor of nearly 100 to 1, resulting in very different reported values for the same sample.
Christenson RH, Azzazy HME. Biochemical markers of the acute coronary syndrome. Clin Chem 1998; 44:1855–1864. 10. Christenson RH, Duh SH, Apple FS, et al. Standardization of cardiac troponin I assays: round robin of ten candidate reference materials. Clin Chem 2001;47:431–437. 11. Moss DW, Henderson AR. Clinical Enzymology. In: Burtis CA and Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. WB Saunders, Philadelphia, PA, 1999, pp. 617–721. 12. Lott JA, Stang JM. Serum enzymes and isoenzymes in the diagnosis and differential diagnosis of myocardial ischemia and necrosis.