Cardiac Markers

Cardiac Markers

Preface Cardiac Markers

Kent B. Lewandrowski, MD Editor

The past decade has seen significant progress in the development and commercialization of cardiac biomarkers for acute coronary syndromes, heart failure, and risk assessment for cardiovascular disease. Major developments include: 1. The development of rapid whole blood point-of-care tests for troponin, creatine kinase isoenzyme CK-MB, myoglobin, and B-type natriuretic peptides 2. Widespread implementation of B-type natriuretic peptide testing (including BNP and NT-proBNP) for the diagnosis and management of heart failure 3. The development of progressively more analytically sensitive cardiac troponin assays, culminating in the current high-sensitivity troponin assays that are coming onto the market today 4. Comercialization of new cardiac biomarkers including ST2 and galectin-3 for risk stratification in heart failure 5. Recognition of troponin (either I or T) as the gold-standard biomarker for myocardial cell necrosis replacing CK-MB in “rule out” myocardial infarction protocols 6. Identification of genetic mutations associated with heart disease and the development of molecular diagnostic assays for the diagnosis of these disorders 7. Consensus statement publications on the new universal definition of myocardial infarction.1 8. Rigorous definition of appropriate cutoff values for cardiac troponin assays emphasizing the use of the 99th percentile of the normal reference population as the accepted cutoff value for clinical use. Collectively these developments have resulted in significant changes to the laboratory approach to patients with cardiovascular disease. Going forward, further improvements are to be expected. For this reason the editors of Clinics in Laboratory Medicine determined that an issue focused on laboratory testing in cardiovascular

Clin Lab Med 34 (2014) xi–xii http://dx.doi.org/10.1016/j.cll.2013.12.001 labmed.theclinics.com 0272-2712/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.

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disease would be both timely and educational to our readers. Topics included in this issue are: 1. Overview of cardiac markers in heart disease 2. Cardiac markers of myocardial necrosis: a history and discussion of milestones and emerging new trends 3. Clinical features of acute coronary syndromes and heart failure 4. Methodologies for measurement of cardiac markers 5. Natriuretic peptides in heart failure and acute coronary 6. Troponins and high-sensitivity troponins 7. Point-of-care testing for cardiac markers 8. Soluble ST-2 and galectin-3 in patients with heart failure 9. Cardiac markers following heart surgery and percutaneous coronary intervention 10. Cholesterol, lipoproteins, high-sensitivity C-reactive protein, and other risk factors for atherosclerosis 11. Special topics: cardiac markers in myocarditis and cardiac transplant rejection and conditions other than acute coronary syndrome 12. New molecular genetic tests in the diagnosis of heart disease 13. Biomarkers for cholesterol absorption and synthesis in hyperlipidemic patients: role for therapeutic selection balance The authors of the individual articles include both laboratory professionals and physicians in clinical practice. We wish to thank the authors for their willingness to contribute to this special edition and hope that the information contained in the articles is educational and of practical use to laboratory professionals and to clinicians who care for patients with cardiovascular disease. DEDICATION

I dedicate this issue to my family for their support and guidance. Kent B. Lewandrowski, MD Gray 5 Chemistry Massachusetts General Hospital Boston, MA 02114, USA E-mail address: [email protected] REFERENCE

1. Thygesen K, Alpert J, Jaffe A, et al. Third universal definition of myocardial infarction. Circulation 2012;126:2020–35.