Skip to main content
SpringerLink
Log in

Cardiac markers: a clear cause for point-of-care testing

  • Review
  • Published:
Analytical and Bioanalytical Chemistry Aims and scope Submit manuscript

Abstract

Point-of-care testing (POCT) in patients with ischemic heart disease is driven by the time-critical need for fast, specific, and accurate results to initiate therapy instantly. According to current guidelines, the results of the cardiac marker testing should be available to the physician within 30 min (“vein-to-brain” time) to initiate therapy within 60–90 min (“door-to-needle” time) after the patient has arrived at the emergency room or intensive care unit. This article reviews the current efforts to meet this goal (1) by implementing POCT of established biochemical markers such as cardiac troponins, creatine kinase MB, and myoglobin, in accelerated diagnosis and management workflow schemes, (2) by improving current POCT methods to obtain more accurate, more specific, and even faster tests through the integration of optical and electrochemical sensor technology, and (3) by identifying new markers for the very early and sensitive detection of myocardial ischemia and necrosis. Furthermore, the specific requirements for cardiac POCT in regard to analytical performance, comparability, and diagnostic sensitivity/specificity are discussed. For the future, the integration of new immunooptical and electrochemical chip technology might speed up diagnosis even further. However, every new development will have to meet the stringent method validation criteria set for corresponding central laboratory testing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Thygesen K, Alpert JS, White HD (2007) Eur Heart J 28:2525

    Article  Google Scholar 

  2. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AH, Christenson RH (2007) Circulation 115:e356–e375

    Article  Google Scholar 

  3. Hand M, Brown C, Horan M, Simons-Morton D (1998) J Thromb Thrombolysis 6:19

    Article  Google Scholar 

  4. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee (1995) Am J Emerg Med 13:188

    Google Scholar 

  5. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee (1995) Am J Emerg Med 13:67

    Google Scholar 

  6. Alpert JS, Thygesen K, Antman E, Bassand JP (2000) J Am Coll Cardiol 36:959

    Article  CAS  Google Scholar 

  7. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE III, Steward DE, Theroux P, Alpert JS, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC Jr (2000) J Am Coll Cardiol 36:970

    Article  CAS  Google Scholar 

  8. Ferguson JL, Beckett GJ, Stoddart M, Walker SW, Fox KA (2002) Heart 88:343

    Article  CAS  Google Scholar 

  9. Panteghini M, Cuccia C, Bonetti G, Giubbini R, Pagani F, Bonini E (2002) Clin Chem 48:1432

    CAS  Google Scholar 

  10. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr (1999) Clin Chem 45:1104

    CAS  Google Scholar 

  11. Azzazy HM, Christenson RH (2002) Clin Biochem 35:13

    Article  CAS  Google Scholar 

  12. Yang Z, Min ZD (2006) Clin Biochem 39:771

    Article  Google Scholar 

  13. Altinier S, Zaninotto M, Mion M, Carraro P, Rocco S, Tosato F, Plebani M (2001) Clin Chim Acta 311:67

    Article  CAS  Google Scholar 

  14. Newby LK, Storrow AB, Gibler WB, Garvey JL, Tucker JF, Kaplan AL, Schreiber DH, Tuttle RH, McNulty SE, Ohman EM (2001) Circulation 103:1832

    CAS  Google Scholar 

  15. Apple FS, Ler R, Chung AY, Berger MJ, Murakami MM (2006) Clin Chem 52:322

    Article  CAS  Google Scholar 

  16. Apple FS, Wu AH, Jaffe AS, Panteghini M, Christenson RH, Cannon CP, Francis G, Jesse RL, Morrow DA, Newby LK, Storrow AB, Tang WH, Pagani F, Tate J, Ordonez-Llanos J, Mair J (2007) Circulation 116:e95–e98

    Article  CAS  Google Scholar 

  17. Goldmann BU, Langenbrink L, Matschuck G, Heeschen C, Kolbe-Busch S, Niederau C, Katz N, Wenserit C, Lestin HG, Brinker K, Kuhrt E, Tebbe U, Spanuth E, Hamm CW (2004) Clin Lab 50:1

    CAS  Google Scholar 

  18. Christenson RH, Duh SH, Apple FS, Bodor GS, Bunk DM, Panteghini M, Welch MJ, Wu AH, Kahn SE (2006) Clin Chem 52:1685

    Article  CAS  Google Scholar 

  19. Labugger R, Organ L, Collier C, Atar D, Van Eyk JE (2000) Circulation 102:1221

    CAS  Google Scholar 

  20. Apple FS, Murakami MM, Christenson RH, Campbell JL, Miller CJ, Hock KG, Scott MG (2004) Clin Chim Acta 345:123

    Article  CAS  Google Scholar 

  21. Apple FS (1999) Clin Chem 45:18

    CAS  Google Scholar 

  22. Apple FS, Wu AH, Jaffe AS (2002) Am Heart J 144:981

    Article  Google Scholar 

  23. Jaffe AS, Babuin L, Apple FS (2006) J Am Coll Cardiol 48:1

    Article  CAS  Google Scholar 

  24. Panteghini M, Pagani F (1997) Clin Chem 43:2435

    CAS  Google Scholar 

  25. Ross SM, Fraser CG (1998) Ann Clin Biochem 35(1):80

    Google Scholar 

  26. Apple FS, Parvin CA, Buechler KF, Christenson RH, Wu AH, Jaffe AS (2005) Clin Chem 51:2198

    Article  CAS  Google Scholar 

  27. Tousoulis D, Kampoli AM, Stefanadi E, Antoniades C, Siasos G, Papavassiliou AG, Stefanadis C (2008) Curr Med Chem 15:1288

    Article  CAS  Google Scholar 

  28. Cohn JN, Quyyumi AA, Hollenberg NK, Jamerson KA (2004) Circulation 109:IV31–IV46

    Google Scholar 

  29. Mancini GB, Dahlof B, Diez J (2004) Circulation 109:IV22–IV30

    Article  Google Scholar 

  30. Packard RR, Libby P (2008) Clin Chem 54:24

    Article  CAS  Google Scholar 

  31. Ridker PM, Brown NJ, Vaughan DE, Harrison DG, Mehta JL (2004) Circulation 109:IV6

    Google Scholar 

  32. Vasan RS (2006) Circulation 113:2335

    Article  Google Scholar 

  33. Vittorini S, Clerico A (2008) Clin Chem Lab Med 46:748

    Article  CAS  Google Scholar 

  34. Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC (2004) Emerg Med J 21:29

    Article  CAS  Google Scholar 

  35. Bhagavan NV, Lai EM, Rios PA, Yang J, Ortega-Lopez AM, Shinoda H, Honda SA, Rios CN, Sugiyama CE, Ha CE (2003) Clin Chem 49:581

    Article  CAS  Google Scholar 

  36. Christenson RH, Duh SH, Sanhai WR, Wu AH, Holtman V, Painter P, Branham E, Apple FS, Murakami M, Morris DL (2001) Clin Chem 47:464

    CAS  Google Scholar 

  37. Huber AH, Kampf JP, Kwan T, Zhu B, Kleinfeld AM (2006) Biochemistry 45:14263

    Article  CAS  Google Scholar 

  38. Azzazy HM, Pelsers MM, Christenson RH (2006) Clin Chem 52:19

    Article  CAS  Google Scholar 

  39. Nicholson JK, Foxall PJ, Spraul M, Farrant RD, Lindon JC (1995) Anal Chem 67:793

    Article  CAS  Google Scholar 

  40. Danne O, Mockel M, Lueders C, Mugge C, Zschunke GA, Lufft H, Muller C, Frei U (2003) Am J Cardiol 91:1060

    Article  CAS  Google Scholar 

  41. Chan CP, Wan TS, Watkins KL, Pelsers MM, Vand V, Tang FP, Lam KH, Mill J, Yuan Y, Lehmann M, Hempel A, Sanderson JE, Glatz JF, Renneberg R (2005) Biosens Bioelectron 20:2566

    Article  CAS  Google Scholar 

  42. Apple FS, Wu AH, Mair J, Ravkilde J, Panteghini M, Tate J, Pagani F, Christenson RH, Mockel M, Danne O, Jaffe AS (2005) Clin Chem 51:810

    Article  CAS  Google Scholar 

  43. Fingleton B (2007) Curr Pharm Des 13:333

    Article  CAS  Google Scholar 

  44. Kai H, Ikeda H, Yasukawa H, Kai M, Seki Y, Kuwahara F, Ueno T, Sugi K, Imaizumi T (1998) J Am Coll Cardiol 32:368

    Article  CAS  Google Scholar 

  45. Baldus S, Heeschen C, Meinertz T, Zeiher AM, Eiserich JP, Munzel T, Simoons ML, Hamm CW (2003) Circulation 108:1440

    Article  CAS  Google Scholar 

  46. Malarstig A, Lindahl B, Wallentin L, Siegbahn A (2006) Arterioscler Thromb Vasc Biol 26:1667

    Article  Google Scholar 

  47. Tousoulis D, Antoniades C, Nikolopoulou A, Koniari K, Vasiliadou C, Marinou K, Koumallos N, Papageorgiou N, Stefanadi E, Siasos G, Stefanadis C (2007) Eur J Clin Invest 37:623

    Article  CAS  Google Scholar 

  48. Yan JC, Zhu J, Gao L, Wu ZG, Kong XT, Zong RQ, Zhan LZ (2004) Clin Chim Acta 343:155

    Article  CAS  Google Scholar 

  49. Cassidy A, Chiuve SE, Manson JE, Rexrode KM, Girman CJ, Rimm EB (2008) Arterioscler Thromb Vasc Biol

  50. Heeschen C, Dimmeler S, Hamm CW, Fichtlscherer S, Simoons ML, Zeiher AM (2005) J Am Coll Cardiol 45:229

    Article  CAS  Google Scholar 

  51. Apple FS, Wu AH, Jaffe AS, Panteghini M, Christenson RH (2008) Clin Biochem 41:222

    Article  CAS  Google Scholar 

  52. Clerico A, Fontana M, Zyw L, Passino C, Emdin M (2007) Clin Chem 53:813

    Article  CAS  Google Scholar 

  53. Emdin M, Passino C, Prontera C, Fontana M, Poletti R, Gabutti A, Mammini C, Giannoni A, Zyw L, Zucchelli G, Clerico A (2007) Clin Chem 53:1289

    Article  CAS  Google Scholar 

  54. Tang WH, Francis GS, Morrow DA, Newby LK, Cannon CP, Jesse RL, Storrow AB, Christenson RH (2008) Clin Biochem 41:210

    Article  CAS  Google Scholar 

  55. Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD (2004) Circulation 110:3206

    Article  CAS  Google Scholar 

  56. Lindahl B, Lindback J, Jernberg T, Johnston N, Stridsberg M, Venge P, Wallentin L (2005) J Am Coll Cardiol 45:533

    Article  CAS  Google Scholar 

  57. Wu AH (1998) Clin Chim Acta 272:11

    Article  CAS  Google Scholar 

  58. Zaninotto M, Mion MM, Novello E, Altinier S, Rocco S, Cacciavillani L, Perazzolo MM, Iliceto S, Plebani M (2006) Clin Chem Lab Med 44:1383

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department for Internal Medicine IV, Clinical Chemistry (Central Laboratory), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Ulrich Friess

  2. Laboratory SYNLAB Laboraerzte Leinfelden, Max-Lang-Strasse 58, 70771, Leinfelden-Echterdingen, Germany

    Ulrich Friess & Maik Stark

Authors
  1. Ulrich Friess
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maik Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrich Friess.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Friess, U., Stark, M. Cardiac markers: a clear cause for point-of-care testing. Anal Bioanal Chem 393, 1453–1462 (2009). https://doi.org/10.1007/s00216-008-2573-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00216-008-2573-z

Keywords

Search

Navigation