Pour ingo
Voir le lien en particulier.
Alain
From: EMED-L -- a list for Emergency Medicine practitioners. [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED]
Sent: 15 mai 2006 11:39
To: [EMAIL PROTECTED]
Subject: Re: [EMED-L] question about cardiac marker testing
David et al.
I'm writing an essay for EMedHome on The Future of Cardiac Biomarkers -
look for it in July or later. I'll give a brief presentation at ICEM next
month in Halifax.
Summary: We presently have lab tests for myocyte necrosis (CTnI,
CTnT, CKMB, myoglobin) or myocardial dysfunction (BNP, NT-proBNP), and
all-over-the-map "acute phase reactants" (CRP, WBC, fibrinogen, d-dimer).
Numerous studies are looking at the applicability of proinflammatory
cytokines (interleukin-6, tumor necrosis factor-alpha), markers of plaque
destabilization (matric metalloproteinase 9, myeloperoxidase, intercellular
adhesion molecule 1, vascular adhesion molecule), markers of plaque rupture
(soluble CD40 ligand, placental growth factor, pregnancy-associated plasma
protein A [PAPP-A]), and markers of prenecrosis ischemia (ischemia modified
albumin, unbound free fatty acids, whole blood choline, plasma choline).
There are others - monocyte chemoattractant protein-1, soluble E-selectin,
soluble P-selectin, etc.
There's mixed clinical information yet available, but a lot of research
going on (and more to do). In a few years we may have a "biomarker panel"
including one or two tests from each category and which, if negative, will have
a sensitivity of 99.999% or so (remember that negative predictive value depends
on the population being studied - if you look at a group in which the prevalence
of disease is 5%, then the NPV of doing nothing - or of doing anything - is
95%)
In the meantime if you're curious and have access to the journal Clinical
Chemistry, check out http://www.clinchem.org/cgi/content/full/51/5/810#R11
Joe Lex, MD, FAAEM
Temple University School of Medicine
Department of Emergency Medicine
1009 Jones Hall
Broad and Ontario
Philadelphia, PA 19140
Office: 215 707.5036
Fax: 215 707.3494
[EMAIL PROTECTED]
Temple University School of Medicine
Department of Emergency Medicine
1009 Jones Hall
Broad and Ontario
Philadelphia, PA 19140
Office: 215 707.5036
Fax: 215 707.3494
[EMAIL PROTECTED]
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From: David Levy <[EMAIL PROTECTED]>
I strongly echo Todd's sentiments. I know of no study that allows a single troponin (or any other cardiac biomarker) to be employed with high enough sensitivity to exclude myocardial damage even in the face of a normal ECG.David Levy
