Recent Advances in Point-of-Care Diagnostics for Cardiac Markers.
National and international cardiology guidelines have recommended a 1-hour turnaround time for reporting results of cardiac troponin to emergency department personnel, measured from the time of blood collection to reporting. Use of point-of-care testing (POCT) can reduce turnaround times for cardiac markers, but current devices are not as precise or sensitive as central laboratory assays. The gap is growing as manufacturers of mainframe immunoassay instruments have or will release troponin assays that are even higher than those currently available. These assays have analytical sensitivity that enables detection of nearly 100% of all healthy subjects which is not possible for current POCT assays. Use of high sensitivity troponin results in a lower value for the 99(th) percentile of a healthy population. Clinically, this enables for the detection of more cases of myocardial injury. In order to compete analytically, next generation POCT assays will to make technologic advancements, such as the use of microfluidic to better control sample delivery, nanoparticles or nanotubes to increase the surface-to-volume ratios for analytes and antibodies, and novel detection schemes such as chemiluminescence and electrochemical detectors to enhance analytical sensitivity. Multi-marker analysis using POCT is also on the horizon for tests that complement cardiac troponin.
Department of Laboratory Medicine, University of California , San Francisco.
H B Wu
HB
Alan
B-type natriuretic peptides; Cardiac troponin; microfluidics; point-of-care testing
Am J Clin Pathol. 2007 Aug;128(2):282-6
17638663
Circulation. 1979 Mar;59(3):607-9
761341
JAMA. 2010 Dec 8;304(22):2494-502
21078811
Int J Cardiol. 2004 Feb;93(2-3):113-20
14975536
Clin Chem. 2009 Jul;55(7):1303-6
19478023
Ann Emerg Med. 2005 Jun;45(6):587-91
15940089
Eur Heart J. 2012 Oct;33(20):2551-67
22922414
Arch Pathol Lab Med. 2003 Apr;127(4):456-60
12683874
Am Heart J. 2010 Oct;160(4):583-94
20934551
Circulation. 2000 Sep 12;102(11):1221-6
10982534
J Emerg Med. 2002 Jan;22(1):1-7
11809549
Circulation. 2001 Sep 25;104(13):1483-8
11571240
J Am Coll Cardiol. 2013 Jul 9;62(2):150-160
23643595
Clin Chem. 2007 Apr;53(4):547-51
17384000
Ann Clin Biochem. 2004 Sep;41(Pt 5):397-404
15333192
Clin Biochem. 2013 Aug;46(12):969-978
23623945
J Am Coll Cardiol. 2000 Sep;36(3):959-69
10987628
Br J Cancer. 1992 Feb;65(2):197-200
1739617
Clin Chim Acta. 2009 May;403(1-2):259-60
19361469