October 11, 2005

Alan H.B. Wu, PhD

Medical researchers are making great strides in understanding the basic chemistry of cardiac and cardiovascular pathologies, and this information has led to new diagnostic strategies and new therapeutic options in hospital-based cardiac care. In the clinical laboratory, one of these developments is the evolution of multimarker panels for diagnosing and evaluating patients with cardiac ischemia.

Early efforts to apply algorithms that could aid in the diagnosis of myocardial infarction include the original “chest pain” panel of myoglobin and either CK-MB or total CK, which has since evolved into a panel consisting of troponin and one other test—either myoglobin or CK-MB. As we learned more about the timing of the rise and fall of these markers and their role in the acute coronary syndrome and myocardial infarction, clinical guidelines began to reflect the evidence supporting the use of troponin in MI and ACS, as well as a growing realization that other markers could serve a supporting or auxiliary role in the diagnosis of cardiovascular dysfunction. (See the National Academy of Clinical Biochemistry’s guidelines for use of Biomarkers of Acute Coronary Syndrome and Heart Failure.)

Today numerous investigations are focused on markers of upstream ACS events such as platelet activation, plaque formation, and plaque destabilization. Researchers are now trying to figure out how these analytes might be combined with traditional markers of ACS and MI to produce an optimized cardiac test panel.

But as the body of knowledge surrounding cardiac biomarkers continues to grow, so do questions concerning applications of these markers. What are the ideal attributes of a cardiac marker panel? Which of these markers should be included in a panel in order to offer the most relevant clinical information? What incremental prognostic information is provided by markers unrelated to myocyte necrosis? And, perhaps most importantly, how can we communicate that information to physician end-users in a clinically actionable format?

In this session of Expert Access Live Online, Alan Wu, PhD, Director of Clinical Chemistry at San Francisco General Hospital, will examine these questions and offer some insight into the need for a rational, rapid multimarker approach in the care of patients with myocardial ischemia and symptoms of ACS.