Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI).
View Article and Find Full Text PDFHypercalcemia is a relatively frequent alteration, mostly associated to primary hyperparathyroidism (PHPT) and malignancy-associated hypercalcemia (MAH). Treatment first includes rehydration and loop diuretics, as general measures. Bisphosphonates are considered the drugs of choice due to their long-term management.
View Article and Find Full Text PDFCalcium is essential to homeostasis and functioning of multiple organ systems. Its circulating concentration is maintained within a very tight physiologic range: 2.25 and 2.
View Article and Find Full Text PDFThe evaluation of patients admitted at the emergency department (ED) for chest pain is challenging and involves many different clinical specialists including emergency physicians, laboratory professionals and cardiologists. The preferable approach to deal with this issue is to develop joint protocols that will assist the clinical decision-making to quickly and accurately rule-out patients with non life-threatening conditions that can be considered for early and safe discharge or further outpatient follow-up, rule-in patients with acute coronary syndrome and raise the degree of alert of the emergency physicians on non-cardiac life-threatening emergencies. The introduction of novel biomarkers alongside the well-established troponins might support this process and also provide prognostic information about acute short-term or chronic long-term risk and severity.
View Article and Find Full Text PDFBackground: Setting specifications for analytical quality is always difficult. The risk-management approach might be a way to do so. In this approach, the definition of the required analytical quality is based on the evaluation of patient risk.
View Article and Find Full Text PDFJ Am Soc Echocardiogr
November 2009
Background: The aim of this study was to determine the prognostic role of ventricular-arterial coupling compared with B-type natriuretic peptide (BNP) in patients after myocardial infarctions.
Methods: Forty-one consecutive patients with history of myocardial infarctions were enrolled. Ventricular-arterial coupling was assessed as the ratio between arterial elastance (E(a)) and end-systolic ventricular elastance (E(es)).
Background: The appropriateness of clinical laboratory use in hospital clinical practice is a very debated question. In fact diagnostic tests are essential tools for disease screening or diagnosis but at the same time they represent an important expenditure.
Methods: A quantitative study was conducted in an Italian general hospital with 535 beds and about 27,000 admissions per year.
Background: Left atrial (LA) volume and B-type natriuretic peptide (BNP) represent powerful outcome predictors in patients with heart failure (HF).
Aim: To assess the comparative prognostic role of LA volume (indexed to body surface area, LAVi), left ventricular diastolic dysfunction (LVDD) and BNP levels on long-term outcome in patients with symptomatic but stable chronic HF. methods: We studied consecutively 46 patients with symptomatic stable chronic HF (73 +/- 10 years, 30 men), in sinus rhythm, without significant valvular disease.
Background: Critical values' reporting is an essential requisite for clinical laboratories. Local policies were investigated within an indicative cohort of Italian laboratories to monitor the situation and establish a performance benchmark.
Methods: A five-point questionnaire was administered to 150 laboratory specialists attending the SIMEL (Italian Society of Laboratory Medicine) National Meeting in June 2006.
Background: Brain natriuretic peptide (BNP) is related to symptomatic status and outcome in aortic stenosis (AS) patients. Carbohydrate antigen 125 (CA125) demonstrated recently a BNP-like behaviour in patients with congestive heart failure (CHF) but has never been studied in AS patients. We aimed to assess the role of CA125 and BNP in AS patients.
View Article and Find Full Text PDFThe recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) has introduced the measurement of cardiac troponin as the biochemical standard for the diagnosis of MI. This change has been mainly driven by the demonstration that any amount of myocardial damage, as detected by cardiac troponins, implies a worse long-term outcome of the patient. The results of several studies consistently show that there is a continuous relationship between the degree of troponin elevation and the patient's prognosis.
View Article and Find Full Text PDFThe recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) has introduced the measurement of cardiac troponin as the biochemical standard for the diagnosis of MI. This change has been mainly driven by the demonstration that any amount of myocardial damage, as detected by cardiac troponins, implies a worse long-term outcome of the patient. The results of several studies consistently show that there is a continuous relationship between the degree of troponin elevation and the patient's prognosis.
View Article and Find Full Text PDFBackground: The management of patients with acute chest pain is a common and difficult challenge from the epidemiological, clinical, organizational and malpractice points of view. Our purpose was to test and implement a simple clinical protocol for the management of patients with acute chest pain and at low-risk for an acute coronary syndrome (ACS) at the time of admission to the Emergency Department (ED).
Methods: During a 5-month study period, 570 consecutive patients were admitted to the ED with acute chest pain: 224 patients were excluded owing to the presence of a clear diagnosis of an ACS or of high-risk factors.
Cardiac troponin T and I are highly sensitive and specific biochemical markers for the detection of myocardial damage and they are now considered the preferred markers for the diagnosis of myocardial infarction. Despite this, in some cases elevations in the serum levels of cardiac troponin T and I are not associated with a final diagnosis of cardiac necrosis. These false-positive results are to be related to different interferences in immunometric assays.
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