A review of cardiac troponin I detection by surface enhanced Raman spectroscopy: Under the spotlight of point-of-care testing.

Cardiac troponin I (cTnI) is a biomarker widely related to acute myocardial infarction (AMI), one of the leading causes of death around the world. Point-of-care testing (POCT) of cTnI not only demands a short turnaround time for its detection but the highest accuracy levels to set expeditious and adequate clinical decisions. The analytical technique Surface-enhanced Raman spectroscopy (SERS) possesses several properties that tailor to the POCT format, such as its flexibility to couple with rapid assay platforms like microfluidics and paper-based immunoassays. Here, we analyze the strategies used for the detection of cTnI by SERS considering POCT requirements. From the detection ranges reported in the reviewed literature, we suggest the diseases other than AMI that could be diagnosed with this technique. For this, a section with information about cardiac and non-cardiac diseases with cTnI release, including their release kinetics or cut-off values are presented. Likewise, POCT features, the use of SERS as a POCT technique, and the biochemistry of cTnI are discussed. The information provided in this review allowed the identification of strengths and lacks of the available SERS-based point-of-care tests for cTnI and the disclosing of requirements for future assays design.

Increased circulating macrophage migration inhibitory factor levels are associated with coronary artery disease

BACKGROUND: To evaluate the macrophage migration inhibitory factor and E-selectin levels in patients with acute coronary syndrome. MATERIALS/METHODS: We examined the plasma migration inhibitory factor and E-selectin levels in 87 patients who presented with chest pain at our hospital. The patients were classified into two groups according to their cardiac status. Sixty-five patients had acute myocardial infarction, and 22 patients had non-cardiac chest pain (non-coronary disease). We designated the latter group of patients as the control group. The patients who presented with acute myocardial infarction were further divided into two subgroups: ST-elevated myocardial infarction (n = 30) and non-ST elevated myocardial infarction (n = 35). RESULTS: We found higher plasma migration inhibitory factor levels in both acute myocardial infarction subgroups than in the control group. However, the E-selectin levels were similar between the acute myocardial infarction and control patients. In addition, we did not find a significant difference in the plasma migration inhibitory factor levels between the ST elevated myocardial infarction and NST-elevated myocardial infarction subgroups. DISCUSSION: The circulating concentrations of migration inhibitory factor were significantly increased in acute myocardial infarction patients, whereas the soluble E-selectin levels were similar between acute myocardial infarction patients and control subjects. Our results suggest that migration inhibitory factor may play a role in the atherosclerotic process. .

Utilidad de Fibrinolisis en pacientes con infarto agudo de miocardio durante las seis primeras horas de evolución / Usefulness of fibrinolysis in patients with acute myocardial infarction during the first six hours of development

Objetivo: determinar el grado de preservación de la función cardíaca después de infarto agudo de miocardio (IAM), mediante la aplicación de fibrinolisis con previa administración de antiagregantes plaquetarios dentro de las primeras seis horas de evolución y establecer el número de pacientes que fueron sometidos a revascularización posterior a la fibrinolisis. Metodología: estudio observacional, prospectivo, realizado en el hospital regional del IESS “Dr. Teodoro Maldonado Carbo”, de Guayaquil; el tamaño muestral fue de 35 pacientes; quienes fueron sometidos a fibrinolisis luego de presentar infarto agudo de miocardio (con elevacióndel segmento ST). Debido a que la muestra fue homogénea se utilizaron como medidas estadísticas media aritmética, y desviación estándar. Además, prueba de Chi cuadrado para obtener el valor p. Resultados: de los 35 pacientes de la muestra, 28 (80 por ciento) fueronhombres y 7 (20 por ciento) mujeres. A todos los pacientes se los sometió a terapia fibrinolítica; en 20 (57 por ciento) el tratamiento resultó eficaz mientras que a 15 (43 por ciento), se les realizó revascularización con STENT. Se observó una mejoría de los valores de fracción de eyección diferencial, que compara los niveles después del tratamiento realizado, con 17 por ciento±7 para pacientes sometidos sólo a fibrinolisis y de 19 por ciento±12 a quienes se les realizó posteriormente revascularización con STENT. Conclusión: a partir de los resultados se puede concluir que la fibrinolisis como medida terapéutica en el manejo agudo del IAM mejora el grado de función cardíaca.

Aim: to determine the degree of perseveration of the cardiac function after an acute myocardial infarction (AMI), through the application of fibrinolysis with prior use of antiplatelet agents within the first six hours of development and to establish the number of patients who underwent a subsequent revascularization to fibrinolysis. Methodology: The prospective observational research took place at the “Dr. Teodoro Maldonado Carbo” IESS Regional Hospital of Guayaquil. The sample size was 35 patients; who underwent fibrinolysis after presenting an acute myocardial infarction (with ST segment elevation). Due to the homogeneous sample, Arithmetic Mean and Standard Deviation were used as statistical measures. In addition, Chi-squared test was used for the p value. Results: out of the 35 patients of the sample, 28 (80 percent) were male and 7 (20 percent) were women. All the patients weresubjected to a fibrinolytic therapy, in 20 (57 percent) of them the mentioned treatment was effective while 15 (43 percent) patients underwent a revascularization with STENT. An improvement of the values of the fraction of differential ejection was observed, which compares the levels after the treatment, with 17 percent±7 for patients undergoing only fibrinolysis, and 19 percent±12 who subsequently underwent a revascularization STENT. Conclusion: from the results it can be concluded that the fibrinolysis as a therapeutic measure in acute management of AMI improves the level of cardiac function.

Diagnóstico y tratamiento de la angina inestable aguda e infarto miocárdico sin elevación del segmento ST / Diagnosis and treatment of acute unstable angina and myocardial infarction without ST segment rise

La angina inestable aguda y el infarto miocárdico sin elevación del segmento ST son dos grandes afecciones del síndrome coronario agudo. Su frecuencia se incrementa con los novedosos y rápidos procedimientos terapéuticos que mejoran la supervivencia del paciente coronario. La presente investigación expone las clasificaciones más actuales, la fisiopatología, las causas y sus mecanismos patogénicos, los hallazgos según la coronariografía y las categorías de riesgo según los elementos clínicos, enzimáticos y electrocardiográficos cuyos marcadores contribuyen al diagnóstico y al pronóstico de ambas dolencias. Se valoran los diagnósticos diferenciales, la conducta médica y el arsenal terapéutico disponible en los distintos estadios de la angina inestable aguda, del infarto, de la angina refractaria y de Prinzmetal. Finalmente se presenta un algoritmo que resume el tratamiento en el síndrome coronario agudo sin elevación del segmento ST (AU)

The acute unstable angina and the myocardial infarction without ST segment rise are two major affections of acute coronary syndrome. Its frequency is increases with the novel and fast therapeutical procedures improving the coronary patient survival. Present research shows the more current classifications, the pathophysiology, the causes and its pathogenic mechanisms, the findings according the coronarygraphy and the risk categories according to the clinical, enzymatic and electrocardiographic elements whose markers contributing to diagnosis and prognosis of both diseases. The differential diagnoses, the medical behavior and the therapeutical armamentarium available in the different stages of the acute unstable angina, of infarction, of refractory angina and or the Prinzmetal. Finally, an algorithm summarizing the treatment of the acute coronary syndrome without ST segment rise is presented (AU)

Diagnóstico y tratamiento de la angina inestable aguda e infarto miocárdico sin elevación del segmento ST / Diagnosis and treatment of acute unstable angina and myocardial infarction without ST segment rise

La angina inestable aguda y el infarto miocárdico sin elevación del segmento ST son dos grandes afecciones del síndrome coronario agudo. Su frecuencia se incrementa con los novedosos y rápidos procedimientos terapéuticos que mejoran la supervivencia del paciente coronario. La presente investigación expone las clasificaciones más actuales, la fisiopatología, las causas y sus mecanismos patogénicos, los hallazgos según la coronariografía y las categorías de riesgo según los elementos clínicos, enzimáticos y electrocardiográficos cuyos marcadores contribuyen al diagnóstico y al pronóstico de ambas dolencias. Se valoran los diagnósticos diferenciales, la conducta médica y el arsenal terapéutico disponible en los distintos estadios de la angina inestable aguda, del infarto, de la angina refractaria y de Prinzmetal. Finalmente se presenta un algoritmo que resume el tratamiento en el síndrome coronario agudo sin elevación del segmento ST

The acute unstable angina and the myocardial infarction without ST segment rise are two major affections of acute coronary syndrome. Its frequency is increases with the novel and fast therapeutical procedures improving the coronary patient survival. Present research shows the more current classifications, the pathophysiology, the causes and its pathogenic mechanisms, the findings according the coronarygraphy and the risk categories according to the clinical, enzymatic and electrocardiographic elements whose markers contributing to diagnosis and prognosis of both diseases. The differential diagnoses, the medical behavior and the therapeutical armamentarium available in the different stages of the acute unstable angina, of infarction, of refractory angina and or the Prinzmetal. Finally, an algorithm summarizing the treatment of the acute coronary syndrome without ST segment rise is presented