Markers in Cardiology - AHA: Current and Future Clinical Applications (American Heart Association Monograph Series) [Hardcover]

Jesse E. Adams (Editor), Fred S. Apple (Editor), Allan S. Jaffe (Editor), Alan H. B Wu PhD (Editor)

Book Description

Publication Date: May 28, 2001 | ISBN-10: 0879934727 | ISBN-13: 978-0879934729 | Edition: 1

Diagnostic accuracy is critical for the identification and treatment of patients with potential cardiac disease. There is now an ever-increasing reliance on the measured levels of diverse proteins (i.e. markers) whose presence in varying amounts can suggest certain cardiovascular pathologies and help to identify optimal therapeutic alternatives. Cardiac Markers: Current and Future Applications is designed to familiarize the reader with these concepts, and to facilitate the application of these concepts to patients with cardiac disease.

The chapters in this monograph detail the past, present, and potential future of markers used for the detection of myocardial injury and for risk assessment as part of a cardiovascular disease work-up strategy. The strengths of this extensive overview, written by many of the current leaders in the field, lie in the evidence presented in addressing analytical/technical, clinical, and outcome-assessments of each biomarker currently used in clinical practice, and for those being investigated as potential cutting-edge tools. Clinical cardiologists, pathologists, researchers, and critical and primary care physicians interested in the clinical application of blood-based assays in cardiac patients will all learn from this monograph.

Editorial Reviews

From The New England Journal of Medicine

Interest in biochemical markers in cardiology has increased tremendously in the past decade. Previously, biochemical markers were used mainly for retrospective verification of acute myocardial infarction. However, as more specific and sensitive markers of myocardial damage (e.g., troponin T and I) have become available, the focus has shifted to early diagnosis of myocardial damage, risk stratification, and selection of treatment. Furthermore, biochemical markers in cardiology are no longer equivalent to markers of myocardial damage. Markers of inflammation (e.g., C-reactive protein) and cardiac dysfunction (e.g., the natriuretic peptides) are already used in clinical practice. Markers of coronary artery disease, ischemia, and activity in the coagulation and fibrinolytic systems are more experimental. It is important for every clinician caring for patients with cardiac disease to understand the advantages and, just as important, the limitations of these markers and to know how to integrate them into approaches to management.

For these reasons, Markers in Cardiology is timely. It summarizes current knowledge of a number of cardiac markers and their applications in various clinical settings. The core of the book concerns markers of myocardial damage. Twelve of the 20 chapters deal with the troponins, from a description of the molecules to a discussion of how to integrate them into diagnostic and treatment algorithms. I particularly hope that the chapters on laboratory analysis and the sensitivity of assays for cardiac troponin will be read carefully by clinicians, since they have a tendency to ignore these issues and jump immediately to applications. Testing for troponins and other cardiac markers at the point of care, a practice that is undoubtedly here to stay, is another well-covered, hot topic. The authors have a generally constructive attitude toward point-of-care testing, and they stress that to make it successful, a close collaboration with the clinical laboratory is essential. Tests for troponins have very high sensitivity and specificity as indicators of myocardial damage, and their use has led to the recognition that myocardial damage occurs frequently in patients thought to have unstable angina. These facts have made the World Health Organization's criteria for acute myocardial infarction obsolete and have necessitated a redefinition of myocardial infarction. The rationale for this is discussed in depth in a chapter that was unfortunately written before the Joint European Society of Cardiology-American College of Cardiology Committee for the Redefinition of Myocardial Infarction published its consensus document but is nevertheless thought provoking. Several chapters deal with the optimal use of tests for troponins in cases in which acute coronary syndromes are suspected. These chapters stress that an integrated approach to the patient is necessary and must take into account factors other than cardiac markers.

The strong focus on the troponins, which undoubtedly are the state-of-the-art markers of myocardial damage and will soon be the standard markers used in clinical practice, is the strength of this book but also its weakness, since other markers of myocardial damage are less well covered. Two new early markers are discussed: fatty-acid-binding protein and creatine kinase MB subforms. The chapter on fatty-acid-binding protein is comprehensive. However, I think the ``old'' markers, creatine kinase MB and myoglobin, deserve chapters of their own in a book on current clinical applications of markers.

Four chapters deal with markers that are not markers of myocardial damage. C-reactive protein, which is a marker of inflammation, and the natriuretic peptides, which are markers of cardiac dysfunction, have valuable clinical applications. Also discussed are the promising initial results of studies with three new markers -- nuclear factor-(kappa)B, a potential marker of coronary artery disease activity; oxidized low-density lipoprotein, a potential marker of coronary artery disease; and malondialdehyde-modified low-density lipoprotein, a possible marker of plaque instability. Obviously, the field of cardiac markers is growing rapidly, and other exciting markers are under evaluation.

This book is an important resource for clinicians seeking information about the expanding field of cardiac markers. Others with an interest in cardiac markers will also find the book valuable.

Bertil Lindahl, M.D., Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

From the Back Cover

The chapters in this monograph detail the past, present and potential future of markers used for the detection of myocardial injury and for risk assessment as part of a cardiovascular disease work-up strategy. The strengths of this extensive overview, written by many of the current leaders in the field, lie in the evidence presented in addressing analytical/technical, clinical, and outcome-assessments of each biomarker currently used in clinical practice, and for those being investigated as potential cutting-edge tools.

Product Details

• Hardcover: 272 pages
• Publisher: Wiley-Blackwell; 1 edition (May 28, 2001)
• Language: English
• ISBN-10: 0879934727
• ISBN-13: 978-0879934729
• Product Dimensions: 6.1 x 9.2 x 0.7 inches
• Shipping Weight: 1.3 pounds (View shipping rates and policies)
• Amazon Best Sellers Rank: #4,384,914 in Books (See Top 100 in Books)