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Cardiac tests
13 Cardiac tests Chapter Objectives: 1. Identify the purpose of certain cholesterol tests used to detect or monitor cardiovascular problems. 2. Identify the cardiac biomarkers tested during an emergency cardiac event. 3. Identify the general lab tests and their purposes for detecting and monitoring cardiovascular diseases. 4. Identify other laboratory tests and their purpose for detecting and monitoring cardiovascular diseases.
Heart disease Lipid profile These cholesterol tests measure the future likelihood of cardiovascular problems.
Test
Purpose
Low-density lipoprotein (LDL)
Determines how much of this lipoprotein is circulating and whether it may be causing blood and vascular problems somewhere in the body Determines how much of this lipoprotein is circulating and whether it is able to control the LDL levels and activity The levels of this lipoprotein are determined by genetics; this test is ordered for patients who have previously been diagnosed with heart disease/ atherosclerosis Non-HDL is the sum total of circulating LDL þ Lp(a) compared with the amount of circulating HDL, to determine the extent of heart and vascular problems somewhere in the body
High-density lipoprotein (HDL) Lipoprotein (a) (Lp(a))
Non-HDL
Emergency cardiac biomarkers Cardiac biomarkers circulate in the blood when the heart is compromised. During or after a cardiac event, biomarkers are measured to help determine risk of insufficient blood flow and Advanced Hematology in Integrated Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817572-9.00013-6 Copyright © 2020 Elsevier Inc. All rights reserved.
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Chapter 13 Cardiac tests
Test
Purpose
Troponin I or T
Elevates soon after heart damage and is maintained for up to 2 weeks to serve as evidence of the damage Used along with troponin to detect a cardiac event Detects troponin at much lower levels • Positive in people with stable angina • Positive in people with no symptoms to predict future cardiovascular events CK-MB is a form of the enzyme creatine kinase found in heart muscle • Rises when there is damage to the heart muscle • Used when the troponin test is not available Detects inflammation somewhere in the body, a present or future indicator of a cardiovascular risk or event Detects heart failure and acute coronary syndrome
Myoglobin High-sensitivity troponin
Creatine kinase and CK-MB
High-sensitivity C-reactive protein BNP (or NT-proBNP)
BNP, brain natriuretic peptide; NT-proBNP, N-terminal prohormone of BNP.
to diagnose ischemia and acute coronary syndrome and cardiac ischemia.
General Lab tests
Test
Purpose
Blood gases
Evaluate blood pH, O2, and CO2 to determine cardiac, pulmonary, and nephritic risk or disease Evaluates liver and kidney metabolism, electrolytes, acid/base balance, glucose, and blood proteins to monitor hypertension and heart disease
Comprehensive metabolic panel or basic metabolic panel Pericardial fluid analysis Blood culture Electrolytes Complete blood count Liver function panel • Alanine transaminase • Aspartate transaminase • Alkaline phosphatase
Fluid amount in the heart sac detects heart inflammation, damage, infection, or failure Detects heart infection (endocarditis) Evaluates minerals, Kþ, Cl, pH, Naþ, Mgþ, Caþ balance and body fluid levels Evaluates blood cell number and quality, presence of infection, and anemia Evaluates liver enzymes for damage that affects blood production
Chapter 13 Cardiac tests
• g-Glutamyl transpeptidase Renal function panel • Blood urea nitrogen (BUN)/creatinine ratio • Creatinine • Creatinine clearance • Basic metabolic panel • Renal function panel • Metabolic panel • Newly diagnosed diabetes • Chronic kidney disease/ diabetes
87
Evaluates kidney metabolism for damage that affects fluid elimination, blood pressure, and diabetes • Albumin • BUN/creatinine ratio • Calcium • Carbon dioxide • Chloride • Creatinine • Estimated glomerular filtration rate • Glucose • Phosphate • Potassium • Sodium • Urea nitrogen
Other laboratory tests These tests allow health practitioners to look at the size, shape, and function of the heart as it is beating. They can be used to detect changes to the rhythm of the heart as well as detecting and evaluating damaged tissues and blocked arteries.
Test
Purpose
Angiogram Chest X-ray Echocardiogram EKG Nuclear scan Stress test
Uses contrasting dye to view and take images of the vessels on X-ray Uses 2D images of the thoracic cavity, including the heart, lungs, air passages, and bones Uses sound waves to take images of the inner structures and motions of the heart Records heart electrical activity using graphs Uses radioactive material to detect and diagnose heart disease Patient is connected to EKG and moves on a treadmill; blood pressure, heart rhythm, and heart rate are measured to determine atherosclerosis
88
Chapter 13 Cardiac tests
Further Reading Aquila I, Cianflone E, Scalise M, et al. c-kit Haploinsufficiency impairs adult cardiac stem cell growth, myogenicity and myocardial regeneration. Cell Death Dis. 2019;10(6):436. https://doi.org/10.1038/s41419-019-1655-5. Published 2019 Jun 4. Chalacheva P, Kato RM, Shah P, et al. Sickle cell disease subjects have a distinct abnormal autonomic phenotype characterized by peripheral vasoconstriction with blunted cardiac response to head-up tilt. Front Physiol. 2019;10:381. https://doi.org/10.3389/fphys.2019.00381. Published 2019 Apr 11. Du Y, Zhang S, Yu H, et al. Autoantibodies against b1-adrenoceptor exaggerated ventricular remodeling by inhibiting CTRP9 expression. J Am Heart Assoc. 2019;8(4):e010475. https://doi.org/10.1161/JAHA.118.010475. lvez-Santisteban M, Chen D, Zhang R, et al. Hemodynamic-mediated Ga endocardial signaling controls in vivo myocardial reprogramming. Elife. 2019; 8, e44816. https://doi.org/10.7554/eLife.44816. Published 2019 Jun 25. Kleiman R, Kuusisto F, Ross I, et al. Machine learning assisted discovery of novel predictive lab tests using electronic health record data. AMIA Jt Summits Transl Sci Proc. 2019;2019:572e581. Published 2019 May 6. Li P, Yan Y, Shi Y, et al. Ncotinic agonist inhibits cardiomyocyte apoptosis in CVB3-induced myocarditis via a3b4-nAChR/PI3K/Akt-dependent survivin upregulation. Oxid Med Cell Longev. 2019;2019:9496419. https://doi.org/ 10.1155/2019/9496419. Published 2019 Mar 7. Lipsett DB, Frisk M, Aronsen JM, et al. Cardiomyocyte substructure reverts to an immature phenotype during heart failure. J Physiol. 2019;597(7):1833e1853. https://doi.org/10.1113/JP277273. Liu X, Qi F, Chen J, et al. The predictive value of infant-specific preoperative pulmonary function tests in postoperative pulmonary complications in infants with congenital heart diseases. Dis Markers. 2019;2019:2781234. https://doi.org/10.1155/2019/2781234. Published 2019 Mar 3. Martinez F, Perna E, Perrone SV, Liprandi AS. Chagas disease and heart failure: an expanding issue worldwide. Eur Cardiol. 2019;14(2):82e88. https:// doi.org/10.15420/ecr.2018.30.2. Published 2019 Jul 11. Pinter A, Szatmari Jr S, Horvath T, et al. Cardiac dysautonomia in depression heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat. 2019;15:1287e1310. https://doi.org/10.2147/ NDT.S200360. Published 2019 May 17. Ranek MJ, Kokkonen-Simon KM, Chen A, et al. PKG1-modified TSC2 regulates mTORC1 activity to counter adverse cardiac stress. Nature. 2019;566(7743): 264e269. https://doi.org/10.1038/s41586-019-0895-y. Samal E, Evangelista M, Galang G, Srivastava D, Zhao Y, Vedantham V. Premature microrna-1 expression causes hypoplasia of the cardiac ventricular conduction system. Front Physiol. 2019;10:235. https://doi.org/ 10.3389/fphys.2019.00235. Published 2019 Mar 18. Siamwala JH, Kumar P, Veeriah V, et al. Nitric oxide reverses the position of the heart during embryonic development. Int J Mol Sci. 2019;20(5):1157. https:// doi.org/10.3390/ijms20051157. Published 2019 Mar 7. Song T, Manoharan P, Millay DP, et al. Dilated cardiomyopathy-mediated heart failure induces a unique skeletal muscle myopathy with inflammation. Skelet Muscle. 2019;9(1):4. https://doi.org/10.1186/s13395-019-0189-y. Published 2019 Jan 24.
Chapter 13 Cardiac tests
Thai PN, Seidlmayer LK, Miller C, et al. Mitochondrial quality control in aging and heart failure: influence of ketone bodies and mitofusin-stabilizing peptides. Front Physiol. 2019;10:382. https://doi.org/10.3389/ fphys.2019.00382. Published 2019 Apr 10. Uddin GM, Zhang L, Shah S, et al. Impaired branched chain amino acid oxidation contributes to cardiac insulin resistance in heart failure. Cardiovasc Diabetol. 2019;18(1):86. https://doi.org/10.1186/s12933-019-08923. Published 2019 Jul 5. Wang CC, Wu CK, Tsai ML, et al. 2019 focused update of the guidelines of the Taiwan society of cardiology for the diagnosis and treatment of heart failure. Acta Cardiol Sin. 2019;35(3):244e283. https://doi.org/10.6515/ ACS.201905_35(3).20190422A. Whitman IR, Vittinghoff E, DeFilippi CR, et al. NT -pro BNP as a mediator of the racial difference in incident atrial fibrillation and heart failure. J Am Heart Assoc. 2019;8(7):e010868. https://doi.org/10.1161/JAHA.118.010868. Wolf P, Beiglböck H, Fellinger P, et al. Plasma renin levels are associated with cardiac function in primary adrenal insufficiency. Endocrine. 2019;65(2): 399e407. https://doi.org/10.1007/s12020-019-01974-1. Yao K, Wang Y, Xu D, et al. Effect of combined testing of ceramides with highsensitive troponin T on the detection of acute coronary syndrome in patients with chest pain in China: a prospective observational study. BMJ Open. 2019; 9(7):e028211. https://doi.org/10.1136/bmjopen-2018-028211. Published 2019 Jul 26. Yin Z, Zhao Y, He M, et al. MiR-30c/PGC-1b protects against diabetic cardiomyopathy via PPARa. Cardiovasc Diabetol. 2019;18(1):7. https:// doi.org/10.1186/s12933-019-0811-7. Published 2019 Jan 11. Zhang J, Tao R, Campbell KF, et al. Functional cardiac fibroblasts derived from human pluripotent stem cells via second heart field progenitors. Nat Commun. 2019;10(1):2238. https://doi.org/10.1038/s41467-019-09831-5. Published 2019 May 20. Zhao WB, Lu Q, Nguyen MN, et al. Stimulation of b-adrenoceptors up-regulates cardiac expression of galectin-3 and BIM through the Hippo signalling pathway. Br J Pharmacol. 2019;176(14):2465e2481. https://doi.org/10.1111/ bph.14674. Zhi Y, Xu C, Sui D, Du J, Xu FJ, Li Y. effective delivery of hypertrophic miRNA inhibitor by cholesterol-containing nanocarriers for preventing pressure overload induced cardiac hypertrophy. Adv Sci (Weinh). 2019;6(11):1900023. https://doi.org/10.1002/advs.201900023. Published 2019 Apr 6.
89
Heart disease Lipid profile These cholesterol tests measure the future likelihood of cardiovascular problems.
Test
Purpose
Low-density lipoprotein (LDL)
Determines how much of this lipoprotein is circulating and whether it may be causing blood and vascular problems somewhere in the body Determines how much of this lipoprotein is circulating and whether it is able to control the LDL levels and activity The levels of this lipoprotein are determined by genetics; this test is ordered for patients who have previously been diagnosed with heart disease/ atherosclerosis Non-HDL is the sum total of circulating LDL þ Lp(a) compared with the amount of circulating HDL, to determine the extent of heart and vascular problems somewhere in the body
High-density lipoprotein (HDL) Lipoprotein (a) (Lp(a))
Non-HDL
Emergency cardiac biomarkers Cardiac biomarkers circulate in the blood when the heart is compromised. During or after a cardiac event, biomarkers are measured to help determine risk of insufficient blood flow and Advanced Hematology in Integrated Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817572-9.00013-6 Copyright © 2020 Elsevier Inc. All rights reserved.
85
86
Chapter 13 Cardiac tests
Test
Purpose
Troponin I or T
Elevates soon after heart damage and is maintained for up to 2 weeks to serve as evidence of the damage Used along with troponin to detect a cardiac event Detects troponin at much lower levels • Positive in people with stable angina • Positive in people with no symptoms to predict future cardiovascular events CK-MB is a form of the enzyme creatine kinase found in heart muscle • Rises when there is damage to the heart muscle • Used when the troponin test is not available Detects inflammation somewhere in the body, a present or future indicator of a cardiovascular risk or event Detects heart failure and acute coronary syndrome
Myoglobin High-sensitivity troponin
Creatine kinase and CK-MB
High-sensitivity C-reactive protein BNP (or NT-proBNP)
BNP, brain natriuretic peptide; NT-proBNP, N-terminal prohormone of BNP.
to diagnose ischemia and acute coronary syndrome and cardiac ischemia.
General Lab tests
Test
Purpose
Blood gases
Evaluate blood pH, O2, and CO2 to determine cardiac, pulmonary, and nephritic risk or disease Evaluates liver and kidney metabolism, electrolytes, acid/base balance, glucose, and blood proteins to monitor hypertension and heart disease
Comprehensive metabolic panel or basic metabolic panel Pericardial fluid analysis Blood culture Electrolytes Complete blood count Liver function panel • Alanine transaminase • Aspartate transaminase • Alkaline phosphatase
Fluid amount in the heart sac detects heart inflammation, damage, infection, or failure Detects heart infection (endocarditis) Evaluates minerals, Kþ, Cl, pH, Naþ, Mgþ, Caþ balance and body fluid levels Evaluates blood cell number and quality, presence of infection, and anemia Evaluates liver enzymes for damage that affects blood production
Chapter 13 Cardiac tests
• g-Glutamyl transpeptidase Renal function panel • Blood urea nitrogen (BUN)/creatinine ratio • Creatinine • Creatinine clearance • Basic metabolic panel • Renal function panel • Metabolic panel • Newly diagnosed diabetes • Chronic kidney disease/ diabetes
87
Evaluates kidney metabolism for damage that affects fluid elimination, blood pressure, and diabetes • Albumin • BUN/creatinine ratio • Calcium • Carbon dioxide • Chloride • Creatinine • Estimated glomerular filtration rate • Glucose • Phosphate • Potassium • Sodium • Urea nitrogen
Other laboratory tests These tests allow health practitioners to look at the size, shape, and function of the heart as it is beating. They can be used to detect changes to the rhythm of the heart as well as detecting and evaluating damaged tissues and blocked arteries.
Test
Purpose
Angiogram Chest X-ray Echocardiogram EKG Nuclear scan Stress test
Uses contrasting dye to view and take images of the vessels on X-ray Uses 2D images of the thoracic cavity, including the heart, lungs, air passages, and bones Uses sound waves to take images of the inner structures and motions of the heart Records heart electrical activity using graphs Uses radioactive material to detect and diagnose heart disease Patient is connected to EKG and moves on a treadmill; blood pressure, heart rhythm, and heart rate are measured to determine atherosclerosis
88
Chapter 13 Cardiac tests
Further Reading Aquila I, Cianflone E, Scalise M, et al. c-kit Haploinsufficiency impairs adult cardiac stem cell growth, myogenicity and myocardial regeneration. Cell Death Dis. 2019;10(6):436. https://doi.org/10.1038/s41419-019-1655-5. Published 2019 Jun 4. Chalacheva P, Kato RM, Shah P, et al. Sickle cell disease subjects have a distinct abnormal autonomic phenotype characterized by peripheral vasoconstriction with blunted cardiac response to head-up tilt. Front Physiol. 2019;10:381. https://doi.org/10.3389/fphys.2019.00381. Published 2019 Apr 11. Du Y, Zhang S, Yu H, et al. Autoantibodies against b1-adrenoceptor exaggerated ventricular remodeling by inhibiting CTRP9 expression. J Am Heart Assoc. 2019;8(4):e010475. https://doi.org/10.1161/JAHA.118.010475. lvez-Santisteban M, Chen D, Zhang R, et al. Hemodynamic-mediated Ga endocardial signaling controls in vivo myocardial reprogramming. Elife. 2019; 8, e44816. https://doi.org/10.7554/eLife.44816. Published 2019 Jun 25. Kleiman R, Kuusisto F, Ross I, et al. Machine learning assisted discovery of novel predictive lab tests using electronic health record data. AMIA Jt Summits Transl Sci Proc. 2019;2019:572e581. Published 2019 May 6. Li P, Yan Y, Shi Y, et al. Ncotinic agonist inhibits cardiomyocyte apoptosis in CVB3-induced myocarditis via a3b4-nAChR/PI3K/Akt-dependent survivin upregulation. Oxid Med Cell Longev. 2019;2019:9496419. https://doi.org/ 10.1155/2019/9496419. Published 2019 Mar 7. Lipsett DB, Frisk M, Aronsen JM, et al. Cardiomyocyte substructure reverts to an immature phenotype during heart failure. J Physiol. 2019;597(7):1833e1853. https://doi.org/10.1113/JP277273. Liu X, Qi F, Chen J, et al. The predictive value of infant-specific preoperative pulmonary function tests in postoperative pulmonary complications in infants with congenital heart diseases. Dis Markers. 2019;2019:2781234. https://doi.org/10.1155/2019/2781234. Published 2019 Mar 3. Martinez F, Perna E, Perrone SV, Liprandi AS. Chagas disease and heart failure: an expanding issue worldwide. Eur Cardiol. 2019;14(2):82e88. https:// doi.org/10.15420/ecr.2018.30.2. Published 2019 Jul 11. Pinter A, Szatmari Jr S, Horvath T, et al. Cardiac dysautonomia in depression heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat. 2019;15:1287e1310. https://doi.org/10.2147/ NDT.S200360. Published 2019 May 17. Ranek MJ, Kokkonen-Simon KM, Chen A, et al. PKG1-modified TSC2 regulates mTORC1 activity to counter adverse cardiac stress. Nature. 2019;566(7743): 264e269. https://doi.org/10.1038/s41586-019-0895-y. Samal E, Evangelista M, Galang G, Srivastava D, Zhao Y, Vedantham V. Premature microrna-1 expression causes hypoplasia of the cardiac ventricular conduction system. Front Physiol. 2019;10:235. https://doi.org/ 10.3389/fphys.2019.00235. Published 2019 Mar 18. Siamwala JH, Kumar P, Veeriah V, et al. Nitric oxide reverses the position of the heart during embryonic development. Int J Mol Sci. 2019;20(5):1157. https:// doi.org/10.3390/ijms20051157. Published 2019 Mar 7. Song T, Manoharan P, Millay DP, et al. Dilated cardiomyopathy-mediated heart failure induces a unique skeletal muscle myopathy with inflammation. Skelet Muscle. 2019;9(1):4. https://doi.org/10.1186/s13395-019-0189-y. Published 2019 Jan 24.
Chapter 13 Cardiac tests
Thai PN, Seidlmayer LK, Miller C, et al. Mitochondrial quality control in aging and heart failure: influence of ketone bodies and mitofusin-stabilizing peptides. Front Physiol. 2019;10:382. https://doi.org/10.3389/ fphys.2019.00382. Published 2019 Apr 10. Uddin GM, Zhang L, Shah S, et al. Impaired branched chain amino acid oxidation contributes to cardiac insulin resistance in heart failure. Cardiovasc Diabetol. 2019;18(1):86. https://doi.org/10.1186/s12933-019-08923. Published 2019 Jul 5. Wang CC, Wu CK, Tsai ML, et al. 2019 focused update of the guidelines of the Taiwan society of cardiology for the diagnosis and treatment of heart failure. Acta Cardiol Sin. 2019;35(3):244e283. https://doi.org/10.6515/ ACS.201905_35(3).20190422A. Whitman IR, Vittinghoff E, DeFilippi CR, et al. NT -pro BNP as a mediator of the racial difference in incident atrial fibrillation and heart failure. J Am Heart Assoc. 2019;8(7):e010868. https://doi.org/10.1161/JAHA.118.010868. Wolf P, Beiglböck H, Fellinger P, et al. Plasma renin levels are associated with cardiac function in primary adrenal insufficiency. Endocrine. 2019;65(2): 399e407. https://doi.org/10.1007/s12020-019-01974-1. Yao K, Wang Y, Xu D, et al. Effect of combined testing of ceramides with highsensitive troponin T on the detection of acute coronary syndrome in patients with chest pain in China: a prospective observational study. BMJ Open. 2019; 9(7):e028211. https://doi.org/10.1136/bmjopen-2018-028211. Published 2019 Jul 26. Yin Z, Zhao Y, He M, et al. MiR-30c/PGC-1b protects against diabetic cardiomyopathy via PPARa. Cardiovasc Diabetol. 2019;18(1):7. https:// doi.org/10.1186/s12933-019-0811-7. Published 2019 Jan 11. Zhang J, Tao R, Campbell KF, et al. Functional cardiac fibroblasts derived from human pluripotent stem cells via second heart field progenitors. Nat Commun. 2019;10(1):2238. https://doi.org/10.1038/s41467-019-09831-5. Published 2019 May 20. Zhao WB, Lu Q, Nguyen MN, et al. Stimulation of b-adrenoceptors up-regulates cardiac expression of galectin-3 and BIM through the Hippo signalling pathway. Br J Pharmacol. 2019;176(14):2465e2481. https://doi.org/10.1111/ bph.14674. Zhi Y, Xu C, Sui D, Du J, Xu FJ, Li Y. effective delivery of hypertrophic miRNA inhibitor by cholesterol-containing nanocarriers for preventing pressure overload induced cardiac hypertrophy. Adv Sci (Weinh). 2019;6(11):1900023. https://doi.org/10.1002/advs.201900023. Published 2019 Apr 6.
89