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Rilevanza clinica e interpretazione dei marcatori biochimici nello scompenso cardiaco
No full textClinical relevance and interpretation of biochemical markers in heart failure. Heart failure (HF) is a global
problem with an estimated prevalence of 38 million patients worldwide. Both prevalence and incidence of HF increase
progressively with population ageing (prevalence ≥10% in people >75 years), especially in the high-income countries.
HF is considered as the fatal event of all cardiovascular disorders. Despite some progress in diagnosis and treatment,
its prognosis is worse than that of most cancers. The disease is heterogeneous in its clinical presentation and the
diagnosis is not based on a single test, but on a combination of the history, physical examination and appropriate
investigations, including some laboratory tests. As a consequence, the accuracy of diagnosis by clinical signs alone
is often inadequate, especially in the early asymptomatic stage of HF. For these reasons, there is an increasing
interest in the development of new biomarkers useful for the diagnosis, prognosis and follow-up of patients with HF.
The aim of this paper is to provide an overview of biomarkers recommended by international guidelines for HF,
discussing their clinical impact and the interpretation of results. Furthermore, a possible strategy for the development
and evaluation of novel prognostic biomarkers for HF will be suggested
Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: Some results
Full text linkLetter to the Editor. Recently, some concerns have been reported about a technical
bulletin by Roche Diagnostics GmbH (Mannheim,
Germany) regarding the adjustment to the calibration
curve of the Elecsys Troponin T high-sensitivity (hs) assay
[1]. According to the bulletin, the goal of the manufacturer
was to recalibrate the control materials of the Troponin T
hs assays to return to the original assay specifications. The
revised lots of calibrators (lots 167345 and 167650) should
yield measurable cardiac troponin T (cTnT) concentrations
in a greater proportion of patient samples for which
the concentrations were undetectable with previous lots,
including lot 163704 [1]. This adjustment regarding calibration
materials may have major implication for patient
care, including the recalculation of the 99th percentile
value for cTnT assay [1], which is the cornerstone of the
definition of myocardial infarction [2].
The aim of the present report is to compare the
results obtained by measuring several plasma samples
of healthy subjects and patients with acute or chronic
cardiac diseases to give the users of Elecsys Troponin
T hs assay some information on the difference in cTnT
values measured using the previous and the new recalibrated
lots
Markers of cardiac remodeling and fibrosis [Marcatori di rimodellamento e fibrosi cardiaca]
No full textCardiac remodeling is considered the determinant of the clinical progression of heart failure. It is defined as a genome expression resulting in molecular, cellular and interstitial changes, clinically manifested as changes in size, shape and function of the heart. Ventricular remodeling occurs progressively in untreated patients after large myocardial infarction and in those with longstanding cardiomyopathy. Myocyte hypertrophy, cellular apoptosis and increased interstitial collagen deposition are the anatomopathological alterations leading to increased myocardial fibrosis. Myocardial hypertrophy and fibrosis increase left ventricular volume and induce perturbation in the left ventricular chamber geometry, leading to cardiac dysfunction. As a result, the assessment of cardiac fibrosis holds important clinical value in patients with heart failure. Accordingly, there is an increasing interest in the development of new markers for cardiac fibrosis and a number of laboratory tests have been recently proposed. The aim of the present article is to discuss analytical performances and clinical relevance of these markers
State of the art of immunoassay methods for B-type natriuretic peptides: An update
Full text linkThe aim of this review article is to give an update on the state of the art of the immunoassay
methods for the measurement of B-type natriuretic peptide (BNP) and its related peptides.
Using chromatographic procedures, several studies reported an increasing number of
circulating peptides related to BNP in human plasma of patients with heart failure. These
peptides may have reduced or even no biological activity. Furthermore, other studies have
suggested that, using immunoassays that are considered specific for BNP, the precursor of the
peptide hormone, proBNP, constitutes a major portion of the peptide measured in plasma of
patients with heart failure. Because BNP immunoassay methods show large (up to 50%)
systematic differences in values, the use of identical decision values for all immunoassay
methods, as suggested by the most recent international guidelines, seems unreasonable. Since
proBNP significantly cross-reacts with all commercial immunoassay methods considered
specific for BNP, manufacturers should test and clearly declare the degree of cross-reactivity of
glycosylated and non-glycosylated proBNP in their BNP immunoassay methods. Clinicians
should take into account that there are large systematic differences between methods when
they compare results from different laboratories that use different BNP immunoassays. On the
other hand, clinical laboratories should take part in external quality assessment (EQA) programs
to evaluate the bias of their method in comparison to other BNP methods. Finally, the authors
believe that the development of more specific methods for the active peptide, BNP1–32, should
reduce the systematic differences between methods and result in better harmonization of
results
Systematic differences between BNP immunoassays: Comparison of methods using standard protocols and quality control materials
Full text linkBackground: Recent studies suggested that there are marked systematic differences among BNP immunoassays.
In this study we compared the BNP data and clinical results obtained with different immunoassays, including a
new method (ST-AIA-PACK, TOSOH Corporation).
Methods: BNP was measured on plasma-EDTA samples of healthy subjects (HS, n = 126) and patients with
heart failure (HF, n = 31 NYHA I, II; n = 46 NYHA III, IV) using the ST-AIA-PACK and the Triage Biosite
(Beckman Coulter) methods. Control samples distributed in the CardioOrmoCheck external quality assessment
were also measured with TOSOH and the most used BNP immunoassays in Italy.
Results: TOSOH method showed a good correlation (R = 0.976; n = 327) but a mean bias (−46.9%) compared
to Triage Biosite. On the base of the results obtained in 10 samples of the CardioOrmoCheck study, TOSOH
method showed a strict agreementwith ADVIA Centaur, while it underestimated BNP in comparisonwith Triage
(−52.5%) and ARCHITECT methods (−39.4%). The agreement of ST-AIA-PACK and Triage Biosite methods for
classification of HF patients was tested using 100 ng/L of BNP; the positive agreement between methods was
65%, overall agreement was 73%.
Conclusions: Our results confirm that there are marked differences in measured values among commercial
methods for BNP assay
Stato dell’arte dell’immunodosaggio dei peptidi natriuretici di tipo B
No full textState of the art of B-type natriuretic peptide (BNP) immunoassays. Recent studies have demonstrated that the
precursor of BNP (proBNP) constitutes the major part of BNP-related peptides detectable in plasma of patients with
heart failure by the commercially available immunoassays considered specific for the BNP hormone. Since proBNP
significantly cross-reacts with commercial immunoassays for BNP, manufacturers should test and clearly declare the
cross-reaction with proBNP in their BNP methods. Owing to the differences in cross-reaction with proBNP as well as
in specificity, respectively, for the NH2- or COOH-terminal part of the peptide hormone chain, BNP immunoassays show
significant between-method differences. Immunoassays for NT-proBNP, which all use standard materials and
antibodies provided by the same company, show lower differences (generally <20%). Clinicians should take into
account these differences among methods when they compare results obtained from different laboratories, which use
different BNP immunoassays. Accordingly, the use of a common decisional limit for all BNP immunoassay methods,
as suggested by the most recent international guidelines, may be unreliable
Evaluation of analytical performance of a novel immunoenzymometric assay for cTnI
Full text linkLetter to the Editor. We evaluated the analytical performance of the immunoenzymometric
assay for the cTnI, named ST AIA-PACK cTnI 3rd-Gen,
using the automated AIA-2000 platform (Tosoh Corporation, Tokyo,
Japan). This method is a two-site immunoenzymometric assay, which
uses a combination of two monoclonal antibodies, respectively directed
to 41–49 and 87–91 amino acids of the cTnI peptide chain, and the ternary
troponin ITC complex as a calibration antigen [1]
Evaluation of reference change values for a hs-cTnI immunoassay using both plasma samples of healthy subjects and patients and quality control samples
No full textComparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform
Full text linkLetter to the Editor. Our data suggest that it is possible
to measure BNP in fresh finger-stick samples of capillary
whole blood with an acceptable reproducibility,
and within 10 – 20 min to obtain results close correlated
to those measured by the automated platform in plasma
blood samples collected from a vein. The measurement
of BNP in fresh finger-stick samples of capillary whole
blood with this POCT method is in particular indicated for
the management of HF patients at home and for the BNP
assay in neonates and children
Adverse events and humoral response after two doses of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) mRNA vaccine in the hospital personnel of a cardiopulmonary tertiary-care center
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