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Nanodevices for Early Diagnosis of Cardiovascular Disease: Advances, Challenges, and Way Ahead
Published in Alok Dhawan, Sanjay Singh, Ashutosh Kumar, Rishi Shanker, Nanobiotechnology, 2018
Alok Pandya, Madhuri Bollapalli
Myoglobin, although not a very specific marker, is the first marker released within 4 hr of damage to myocardial muscle cells. B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), and CRP are released after myoglobin, but they are specific markers for coronary events (Jaffe et al., 2010). BNP is useful for the emergency diagnosis of heart failure and for the prognosis in patients with acute coronary syndromes (ACSs) (Yang et al., 2009). CRP is an important prognostic indicator of CVR and ACS. cTnI has become a standard marker for the detection of acute myocardial infarction (Apple, 2007). During heart infarction, troponin T (TnT) is immediately released to the bloodstream. A biosensor capable of monitoring this biomarker in a short time could improve patient care by allowing a definite diagnosis of myocardial infarction in real time (Han et al., 2016). Elevated concentrations of these cardiac markers in serum are associated with recurrent CVD events and higher death rates. Simultaneous quantification of these biomarkers allows clinicians to diagnose CVD quickly and/or accurately design a patient care strategy. A fast and reliable detection of these proteins would also help medical professionals differentiate diseases among those showing similar symptoms. The clinically significant sensing ranges of myoglobin, BNP, cTnI, and CRP are extremely low (pM to nM); therefore, assay methods for these biomarkers need to be highly sensitive.
Clinical Applications of Immunoassays
Published in Richard O’Kennedy, Caroline Murphy, Immunoassays, 2017
Brain natriuretic peptide (BNP), a cleavage product of the prohormone pro-BNP, is a hormone released predominantly from the heart and is closely related to left ventricular heart pressures. It is particularly useful in diagnosing heart failure where there is considerable myocardial stretch, and increased plasma BNP concentrations can be detected in both symptomatic and asymptomatic left ventricular heart failure patients [27]. In normal healthy individuals, the plasma concentration of BNP is approximately 10 pg L−1. Immunoassays used in the measurement of BNP have a standard ‘cut-off’ value of >100 ng L−1 for a diagnosis of heart failure; however, values vary according to gender, body mass index (BMI) and age. A BNP of <50 ng L−1 can be used to rule out heart failure with a negative predictive value of 96% [28].
Pediatric ventricular assist devices: what are the key considerations and requirements?
Published in Expert Review of Medical Devices, 2020
Roland Hetzer, Mariano Francisco del Maria Javier, Eva Maria Javier Delmo
The EXCOR® Pediatric is implanted in patients with: (a) low cardiac output associated with metabolic acidosis; (b) rapid deterioration of the circulation with cardiac index <2.0 l/min/m2 with inotrope dependence, especially on epinephrine; (c) mixed venous saturation <40%; (d) oliguria (<1 ml/kg/min); (e) critical peripheral perfusion; and (f) echocardiographically confirmed massive impairment of cardiac function despite maximal pharmacological treatment, signs of early renal, hepatic and respiratory failure, and high or progressive increase in B-type natriuretic peptide (BNP) or N-terminal pro-BNP level. Over time, the criteria for Berlin Heart EXCOR implantation have been modified and changed toward earlier implantation before irreversible organ damage occurs or after a few days on ECMO to assess whether recovery from shock sequelae has taken place.