Division of Cardiology, University of Rome Tor Vergata.
Department of Medicine, University of Padova.
J Cardiovasc Med (Hagerstown). 2020 Dec;21(12):953-963. doi: 10.2459/JCM.0000000000001022.
: An enormous amount of experimental and clinical evidence has clearly shown that the measurement of cardio-specific biomarkers is able to significantly and independently improve the diagnostic accuracy and risk stratification in cardiovascular diseases. Furthermore, many recent studies have reported that the measurement of cardio-specific biomarkers has a positive impact also on the management and outcome of patients with cardiovascular diseases. Considering the significant and independent information associated with cardio-specific biomarkers, several studies have recently reported that the combined dosage of natriuretic peptides and cardiac troponins may be convenient not only for the diagnosis, prognosis, and treatment of heart disease, but also for general screening of the population for individuals with high cardiovascular risk. Due to the higher cost of cardio-specific biomarkers compared with other laboratory tests, the clinical adequacy of the combined measurement of natriuretic peptides and cardiac troponins must be carefully evaluated. Consequently, an increase in the clinical use of a laboratory test should be based not only on the favorable pathophysiological characteristics of a biomarker, but also on the high performance of the methods used for biomarker dosing. The purpose of this review is to discuss the clinical relevance and the possible cost efficiency of the combined dosage of natriuretic peptides and cardiac troponins in some clinical conditions, in particular those most frequently observed in patients with critical illnesses admitted to the emergency room.
大量的实验和临床证据清楚地表明，心特有的生物标志物的测量能够显著地独立提高心血管疾病的诊断准确性和风险分层。此外，许多最近的研究报告称，心特有的生物标志物的测量对心血管疾病患者的管理和预后也有积极的影响。鉴于心特有的生物标志物所具有的重要且独立的信息，最近的几项研究报告称，利钠肽和心肌肌钙蛋白的联合检测不仅方便了心脏病的诊断、预后和治疗，也方便了对高心血管风险人群的一般筛查。由于心特有的生物标志物的成本比其他实验室检测高，因此必须仔细评估联合检测利钠肽和心肌肌钙蛋白的临床适宜性。因此，实验室检测的临床应用增加不仅应基于生物标志物有利的病理生理学特征，还应基于生物标志物定量方法的高性能。本文的目的是讨论联合检测利钠肽和心肌肌钙蛋白在某些临床情况下的临床相关性和可能的成本效益，特别是在急诊重症患者中最常观察到的临床情况下。
