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Cardiac biomarkers Flashcards

(51 cards)

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1
Q

What are biomarkers?

A

Biological substances found in body fluids or tissues that signify health or disease or the likelihood of the presence or absence of a particular disease

Biomarkers can indicate underlying clinicopathological processes.

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2
Q

What type of information do biomarkers provide?

A
  • Diagnostic
  • prognostic
  • guide + modify therapy

They can also represent a potential means to guide and modify treatment.

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3
Q

When is cardiac biomarker testing most valuable?

A

When the pretest probabilities of the suspected and alternative conditions are both roughly 50%

This is based on the existing information.

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4
Q

What triggers the production and release of natriuretic peptides?

A

Stretch of the atrial and ventricular myocardium

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5
Q

What is the full form of ANP?

A

Atrial natriuretic peptide

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6
Q

Where is ANP produced?

A

In atrial myocardium

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7
Q

What is the half-life of ANP?

A

1 minute

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8
Q

What is the full form of BNP?

A

B-type natriuretic peptide

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9
Q

Where is B-type natriuretic peptide produced?

A

In atrial and ventricular myocardium

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10
Q

What is the half-life of B-type natriuretic peptide?

A

1.57 minutes

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11
Q

What BNP level is highly suggestive of CHF in dogs?

A

6 pg/ml

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12
Q

What BNP level indicates that CHF is an unlikely cause of respiratory distress in dogs?

A

<3 pg/ml

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13
Q

What is N-terminal pro-BNP (NT-proBNP) in relation to BNP?

A

Related form of BNP produced in a 1:1 relationship with BNP

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14
Q

What is one of the uses of NT-proBNP?

A

Differentiation of cardiac vs. non-cardiac respiratory distress

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15
Q

What NT-proBNP level supports CHF in cats?

A

> 270 pmol/L

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16
Q

What NT-proBNP level does not support CHF in cats?

A

<100 pmol/L

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17
Q

What NT-proBNP level supports CHF in dogs with respiratory signs?

A

> 1,800 pmol/L

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18
Q

What NT-proBNP level does not support CHF in dogs?

A

<900 pmol/L

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19
Q

What are the pros of using NT-proBNP?

A
  • Longer half-life than BNP (1-2hr)
  • Less susceptible to degradation
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20
Q

What is a con of NT-proBNP assays?

A

Samples need to be sent to reference laboratory, prohibiting immediate POC decision making

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21
Q

What are other diseases that can increase NT-proBNP?

Study These Flashcards
A
  • Renal disease
  • Systemic hypertension
  • Hyperthyroidism
  • IVFT

BUT: elevations due to extracardiac conditions are relatively modest –> the greater the elevation, the more likely it’s cardiac

22
Q

What does a positive NT-proBNP ELISA test indicate in cats?

23
Q

What is the recommended cut-off value for NT-proBNP in reference laboratory tests for diagnosing CHF?

24
Q

What is the sensitivity and specificity of the NT-proBNP ELISA test for diagnosing CHF (>100pmol/L)?

Study These Flashcards
A
  • Sensitivity: 93-100%
  • Specificity: 72-87%
25
What is the sensitivity and specificity of NT-proBNP ELISA in pleural effusion?
* Sensitivity: 100% * Specificity: 64%
26
What is the concentration of NT-proBNP in pleural effusion compared to plasma?
pleural effusion > plasma --> should be diluted 1:1 with 0.9% saline
27
What dilution of pleural effusion is recommended in one study?
1:1 with 0.9% saline
28
What is the sensitivity and specificity of NT-proBNP ELISA after diluting pleural effusion with saline?
* Sensitivity: 100% * Specificity: 87%
29
How do you interpret NT-proBNP assays in dogs and cats presenting to the ER with respiratory distress?
30
What is the diagnostic value of performing and NT-proBNP ELISA test in cats?
Rule out of CHF as cause of respiratory distress, BUT not confirmation (due to low specificity)
31
What are cardiac troponins and where can they be found?
3 related molecules located on the actin filaments of myocytes --> cardiac + skeletal muscle (smooth muscle does not have cardiac troponins) ## Footnote Cardiac troponins are specific to cardiac and skeletal muscle, with no troponin present in smooth muscle.
32
What is the function of cardiac troponins?
Site of Ca2+ binding --> initiating actin-myosin cross-bridging --> cardiac contraction
33
What is the significance of cardiac troponin-I?
Cardiac specific --> used for detection and quantification of myocardial injury + diagnosis of underlying heart disease
34
What is the normal range of cTnI in healthy dogs?
cTnI <0.1ng/ml
35
How does the release of cTnI compare to cTnT following injury?
cTnI > cTnT
36
What is the half-life of cardiac troponin-I?
2 hours
37
What is the use of serial measurement of cTnI?
To assess the temporal nature of cardiac injury.
38
What are the diagnostic uses of cTnI?
Detection of myocardial injury and diagnosis of underlying heart disease, especially myocarditis.
39
What indicates myocarditis?
Increased cTnI + arrhythmias IN ABSENCE of readily identifiable cause (MMVD etc.)
40
What is the significance of cTnI levels greater than 10-100x RI?
Indicates myocarditis
41
List 5 cardiac causes for elevation of cTnI.
1. Cardiomyopathy 2. Degenerative valve disease 3. Myocarditis 4. Infectious diseases (Chagas, Dirofilariasis, Ehrlichia, Leptospirosis) 5. Cardiac trauma
42
Is an increase in cTnI sensitive or specific for myocardial injury?
Sensitive for myocardial injury but nonspecific to the etiology.
43
What other diseases can increase cTnI levels?
* Renal disease * Systemic hypertension * Hyperthyroidism * IVFT.
44
What is the limitation of cardiac troponin-T assays?
Limited to a single manufacturer with minimal data.
45
Is cardiac troponin-C cardiac specific?
No, it is not cardiac specific; also found in skeletal muscle.
46
What happens to cardiac troponins during disease?
They are displaced from the actin filament and leak into circulation.
47
How do circulating concentrations of cTnI and cTnT relate to myocardial injury?
Proportional to the extent of myocardial injury.
48
List 6 extracardiac causes for elevation of cTnI.
1. Pancreatitis 2. Heatstroke 3. Hyperthyroidism 4. Neoplasia 5. Systemic hypertensio 6. Renal disease
49
In what diseases has cTnI been used for prognostification?
1. HCM 2. DCM 3. MMVD Patients with lower cTnI --> better survival
50
Which troponins are cardiac specific?
cTnI + cTnT
51
Which troponin is not cardiac specific?
cTnC (also skeletal muscle)

Cardiovascular (21 decks)

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