title: Editor's Choice-Biomarkers of acute cardiovascular and pulmonary diseases.
abstract: Acute cardiothoracic and respiratory diseases frequently remain a challenge to diagnose and differentiate in the emergency setting. The main diseases that manifest with chest pain include ischaemic heart disease, myocarditis, acute pericarditis, aortic dissection/rupture and pulmonary embolism (PE). Diseases that primarily present with dyspnoea include heart failure (HF), acute respiratory distress syndrome (ARDS), pneumonia, asthma exacerbations and chronic obstructive pulmonary disease. Pre-test probabilities of clinical findings play a vital part in diagnostic decisions, and the use of a Bayesian approach to these greatly improves the ability to stratify patients more accurately. However, blood tests (biomarkers) are increasingly used to assist in rapid decision-making in the emergency setting in combination with imaging methods such as chest radiograph, ultrasound and increasingly computed tomography, as well as physiological tests such as the electrocardiogram in addition to physical examination. Specific tests for ischaemic heart disease and myocarditis (cardiac troponins), HF (B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP)), aortic dissection (smooth muscle markers) and PE (D-dimer) have been developed. Surfactant protein-D and interleukin-8 have been developed for ARDS. Additionally, circulating microRNAs have emerged as promising biomarker candidates in cardiovascular disease. With this increasing array of biochemical markers to aid in the diagnosis of chest diseases presenting with chest pain and dyspnoea, we herein review the clinical usefulness of these markers, in particular in differentiating cardiac from pulmonary diseases. A symptom-oriented assessment as necessary for use in the critical setting is described in addition to discussion of individual biomarkers.
authors.affiliation: Department of Cardiovascular Medicine, University of Tokyo, Japan Department of Cardiovascular Sciences, University of Leicester, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK.
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: National Heart and Lung Institute, Imperial College, UK NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lyon
authors.affiliation: Advanced Lung Disease Institute, Banner Good Samaritan Hospital, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Saggar
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK.
authors.forename: Liam M
authors.initials: LM
authors.lastname: Heaney
authors.affiliation: Department of Cardiovascular Medicine, University of Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Aizawa
authors.affiliation: Department of Medical Translational Sciences, 'Federico II' University, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cittadini
authors.affiliation: Division of Cardiology, A.O.R.N. 'A. Cardarelli', Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mauro
authors.affiliation: Heart Department, University Hospital, Salerno, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Division of Cardiology, Second University of Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Limongelli
authors.affiliation: Heart Department, University Hospital, Salerno, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrara
authors.affiliation: Cardiology and Emergency Department, Sant'Antonio Hospital, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.affiliation: National Heart and Lung Institute, Imperial College, UK NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Morley-Smith
authors.affiliation: Division of Cardiology, Second University of Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.affiliation: Heart Department, University Hospital, Salerno, Italy ebossone@hotmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000378:metabolism; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers
keywords: Biomarkers; chest disease; critical care