Speakers
Paul O Collinson
Plenary
Metamorphosis - from retrospective confirmation to management tool, the evolution of cardiovascular biomarkers.
Cardiovascular biomarkers, then known as cardiac enzymes, were first incorporated into the diagnosis of myocardial infarction in 1979. Conventional teaching was that cardiac enzymes, creatine kinase (CK), aspartate transaminase (AST) and lactate dehydrogenase (LDH) were measured serially over three days. At this time management of myocardial infarction (MI) was symptomatic and non-interventional. Retrospective confirmation was all that was required and the electrocardiogram (ECG) was the predominant diagnostic technology. Improved measurement methodology, especially for CK and measurement of its cardiac (MB) isoenzyme (CK-MB) were the only changes. Measurement of natriuretic peptides was a research undertaking. The first technology shift was the concept of immunoassay for cardiac biomarkers with assays developed for myoglobin and CK-MB. Interest in more rapid diagnosis came from the Emergency Department, especially in the United States, and with the advent of thrombolytic therapy. A more proactive approach to management of MI both confirmation and exclusion resulted in the development of rapid serial enzyme measurement and the calculation of delta change. The paradigm shift came with the development of immunoassay for the cardiac specific proteins cardiac troponin T (cTnT) and cardiac troponin I (cTnI) followed by those for B type natriuretic peptides. Measurement of cTnT and cTnI group diagnostically superior to conventional cardiac enzymes as they identified one third of patients said to have unstable angina who had missed, and most importantly, treatable myocardial infarction. The combination of a cardiac specific biomarker tied to a treatment strategy was irresistible. Myocardial infarction was redefined with cardiac troponin integral to diagnosis and treatment strategies. Evolution of measurement technology has produced high sensitivity assays and latterly point of care testing capable of matching the analytical sensitivity of laboratory assays. Incorporation of testing strategies within clinical decision support (artificial intelligence) systems represents the next step on the biomarker journey.
Session chair: Katharine Hayden
Dr P. O Collinson MA MB BChir FRCPath MD FAACC FRCP FESC. Professor of Cardiovascular Biomarkers at St George’s University of London and Honorary Consultant Cardiologist studied at St Catharine’s College Cambridge (Medicine and Biochemistry) and subsequently at St Thomas Hospital and the Royal Free Hospital. He was won several prizes and awards for his work on Cardiovascular Biomarkers (ran the first RCT of cardiac diagnostics) including the Hytest Award (Now IFCC award) for lifetime achievement in cardiovascular biomarkers. Published over 300 papers and review articles. Likes SCUBA diving and photographing sharks. Especially the ones with big teeth.