Clinical evaluation of biochemical markers of cardiovascular disease : an evidence based approach
Introduction: Laboratory markers play an important role in early risk stratification diagnosis and management for patients presenting with different heart problems. However, the role of such markers as diagnostic tests remains unclear when applied to real life patient’s cohorts, especially when it is accompanied by incorrect time of measurement and interpretation of final results. Methods: We have assessed the role of a variety of markers (hFABP, myoglobin, cTnI, PAPP-A, hsCRP, hsp70, and ADP/ATP) with respect to their diagnostic and prognostic value using an evidence-based approach in pragmatic real life cohorts (patients with ACS, patienst undergoing cardiac surgery and patients with AF). Results: Measurement of myoglobin and hFABP in patients presenting with ACS offers no additional value to the measurement of cTnI on admission and at 12 hours. PAPP-A measurement may be useful at detecting unstable plaque disease. Post-operative measurement of cTnI in patients undergoing cardiac surgery is useful at detecting post-operative complications and at predicting subsequent mortality. An inflammatory component, as indicated by the measurement of hsCRP may be associated with the initiation of AF. Conclusions: The evaluation of biochemical marker in real-life patients cohorts is essential to understand the true relationships present in the exact patient cohorts that the tests will subsequently be used in. Larger studies are required for both new and current markers.