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CARDIAC MARKERS REVOLUTIONIZED THE DIAGNOSIS OF CARDIAC DAMAGE Dr.Anil Batta & Dr.KMDS Panag Dep't of Medical Biochemistry Baba Farid Univ. of Health Sciences India Abstract Cardiac markers enable the diagnosis and characterization of cardiac diseases. While the highly sensitive troponin assay is specific for myocardial infarction, myeloperoxidase is a powerful tool for early determination of plaque formation. Homocysteine is independently associated with numerous neurodegenerative diseases, Cardiovascular events and stroke in particular. Elevated plasma concentrations predict outcome and help identify high-risk groups most likely to benefit from prevention and therapy. Homocysteine turned out as a valuable marker for early diagnoses of folate and B-vitamin deficiencies that are involved in anemias and numerous chronic diseases. This article presents the innovative marker MPO, the well established marker troponin and the versatile and useful marker homocysteine, and explains their importance in cardiac patient management Introduction James et al. compared the results produced by the individual assays and evaluated them on the basis of one-year mortality. The assay systems used differed in the selection and number of antibodies used and featured varying sensitivities in reference to these. This study illinois bunn replicas demonstrated that inclusion of at least two monoclonal antibodies against epitopes at the N terminal part of the heart specific region of troponin seemed critical for optimum performance The Architect TnI assay is based on three different antibodies against the stable NH2 terminal end (regions 24 to 40 and 41 to 49) and against the mid stable COOH terminal end(region 87 to 91; Another advantage of the Architect TnI assay is its quick turn around time of less than 18 minutes. Integration with clinical chemistry is possible, Enabling fully integrated cardiac testing The liposomal enzyme myeloperoxidase.(MPO) plays a major role in the regulation and termination of inflammatory processes. It is a hemoproteine stored in the leukocytes and will be secreted during phagocyte activation. MPO has emerged:-- As an important potential participant in the atherosclerotic process. It is both a disease marker in atherosclerosis with vulnerable plaques and an event marker for plaque rupture, and thus helps in the early diagnosis of acute myocardial infarction. Clinical studies Have shown MPO to be an independent early marker in the prognosis and risk stratification of patients with chest pain and suspected acute coronary syndrome (2). Here MPO offers decisive advantages over troponin and other biomarkers for early diagnosis. It is significantly increased during the first four hours after the onset of chest pain replica watches ball illinois and replica hampden special railway watch then slowly decreases again to reach a plateau after 24 hours. Troponin, on the other hand, usually increases after four hours or later (depending on the clinical sensitivity). As a marker of risk for worsening heart failure, increasing tertiles of plasma MPO levels were predictive of mortality. Elevated MPO levels chopard imperiale replica can also predict future risk of coronary artery disease in apparently healthy individuals (3). Homocysteine (Hcy) is a non-protein amino acid and part of different metabolic pathways like the methionine cycle for the vitamin -B-dependent transfer of methyl groups for biosynthesis (4). Elevated Hcy levels have a pro-oxidative effect and directly increase the risk for atherothrombotic disease, dementia, e.g. Alzheimer's disease, depression and osteoporosis. Hcy has a toxic effect on cells and is also an independent risk marker for cardiovascular disease, stroke, diabetes and cognitive impairment. Folic acid, vitamin B12 or vitamin B6 deficiencies cause Hcy Levels to increase. Patients with high concentrations of total homocysteine have an increased risk of stroke. In arterial fibrillation the risk is increased more than fourfold (5). As Hcy and diabetes have synergetic detrimental vascular effects, Hcy screening of diabetes patients is recommended (6). In addition, diabetes patients have an incremental risk for developing cardiovascular disease and cognitive impairment, if Hcy is elevated. In studies, both the Architect and the Axsym homocysteine assays demonstrated high performance and reproducible results. Architect homocysteine showed a good correlation to Axsym homocysteine. Figure 1 Schematic design of troponin. mAb1, mAb2 and mAb3 are three monoclonal antibodies used in the Architect and Axsym TnI assays for troponin measurement. mAb1 mAb2 mAb3 N-term C-term124 40 41 49 87 91 210 Figure 2 Metabolic pathways of homocysteine. Illustration of the different cycles and essential vitamins, e.g. folic acid, vitamin B12, and vitamin B6. References 1. Stefan J, buy rolex date Mats F, Nina J, Bertil L, Per V. The antibody configurations of cardiac troponin I assays may determine their clinical performance. Clin Chem. 2006; 52 (5): 832-7. 2. Baldus S, Heeschen Ch, Meinertz T, et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation 2003; 108 (12): 1440-5 3. Meuwese MC, Stroes ESG, Hazen SL, et al. Serum myeloperoxidase levels are associated with the future risk of coronary artery disease in apparently healthy individuals: fake howard series o watches the EPIC-Norfolk Prospective Population Study. J Am Coll Cardiol 2007; 50 (2): 159-65 .4. Refsum H, Ueland PM, Nygard O, Vollset SE. Homocysteine and cardiovascular disease. Annul Rev Med. 1998; 49: 31-62. 5. Spence JD. Homocysteine-lowering therapy: a role in stroke prevention? Lancet Neurol 2007, 6: 830-8. 6. Huijberts MSP, Becker A, Stehouwer CDA. Homocysteine and vascular disease