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New biochemical markers: from bench to bedside
Martina Zaninotto1, Monica Maria Mion, Enrica Novello
1Department of Laboratory Medicine, University-Hospital of Padova, Italy.
Insights
New biochemical markers can improve early risk assessment for acute coronary syndrome (ACS) beyond troponin levels. Developing and implementing these cardiac biomarkers requires collaboration for accurate clinical interpretation and patient stratification.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Diagnostics
Background:
- Evaluating patients with chest pain for acute coronary syndrome (ACS) is challenging, time-consuming, and costly.
- While troponins detect cardiac injury, normal values do not exclude cardiac event risk.
- Advances in understanding atherosclerosis and molecular disease progression enable new biochemical marker development.
Purpose of the Study:
- To explore the potential of novel biochemical markers for earlier and more accurate cardiovascular risk assessment.
- To identify biomarkers reflecting inflammation and plaque instability for improved prognosis and risk stratification.
- To outline the requirements for effective clinical implementation of new cardiovascular biomarkers.
Main Methods:
- Review of recent investigations into the pathobiology of atherosclerosis and cardiovascular disease.
- Identification of selected biomarkers released during cardiovascular disease development.
- Focus on markers indicating inflammatory processes and plaque instability.
- Consideration of marker requirements: biological plausibility, cost-effective assays, and clinical interpretation.
Main Results:
- Emerging biomarkers offer insights into inflammatory processes and plaque instability.
- These markers can aid in prognosis and risk stratification for cardiovascular disease.
- Successful implementation requires high-quality, rapid assays and optimal clinical cut-offs.
Conclusions:
- Translating new biomarker discoveries requires robust analytical characterization and routine assay development.
- Effective use necessitates standardized performance assessment, clear interpretative reporting, and physician training.
- Coordinated efforts among clinicians, technologists, statisticians, and industry are crucial for optimizing biomarker value.
Background:
Evaluation of patients presenting to hospital with chest pain or other signs or symptoms suggesting acute coronary syndrome (ACS) is problematic, time-consuming and sometimes expensive, even if new biochemical markers, such as troponins, have improved the ability to detect cardiac injury. However, patients with normal troponin values are not necessarily risk-free for major cardiac events.
Methods:
Recent investigations indicate that the overall patient risk may be assessed earlier than before, thanks to new knowledge acquired concerning the pathobiology of atherosclerosis and molecular events involved in the progression of disease, thus allowing the development of new biochemical markers. Some selected markers are released during the different phases of development of cardiovascular disease and may be useful for the diagnosis of patients with cardiovascular disease. In particular, the identification of emerging markers that provide relevant information on the inflammatory process, and the development of biomarkers whose circulating concentrations suggest the status of plaque instability and rupture, seems to be of particular value in prognosis and risk stratification. The overall expectations for a cardiovascular biochemical marker are not only its biological plausibility but also the availability at a reasonable cost of rapid, high quality assays, and their correct interpretation by clinicians using optimal cut-offs.
Conclusion:
The crossing from bench to bedside for each new marker discovered, must be associated with concurrent advances in the characterization of analytical features and the development of routine assay, in the assessment of analytical performance and in interpretative reporting of test results as well as in the training of physicians to use the array of biomarkers available appropriately and to interpret them correctly. This approach calls for the coordinated support of clinicians, technology experts, statisticians and the industry so that new biochemical developments can be of optimal value.
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