David W. Holt – författare

This publication takes a critical, evidence-based look at the efficacy of diagnostic tests which are increasingly being used to evaluate organ damage and dysfunction. The use of biomarkers is growing, with a steady stream of products being brought out by the pharmaceutical industry. Some of these assist in diagnosis, others provide a means of monitoring the state of progression of disease and the effectiveness of therapeutic options. However, in many cases the evidence which supports the use of these methods as opposed to traditional biochemical tests has not yet been demonstrated, and it is intended that this volume will help clarify the strengths and weaknesses of using these biomarkers across a wide range of applications and in the various organs of the body. This approach will provide pathologists, clinical biochemists and medical laboratory scientists with an invaluable overview of the diverse applications of biomarkers in medicine.

This publication takes a critical, evidence-based look at the efficacy of diagnostic tests which are increasingly being used to evaluate organ damage and dysfunction. The use of biomarkers is growing, with a steady stream of products being brought out by the pharmaceutical industry. Some of these assist in diagnosis, others provide a means of monitoring the state of progression of disease and the effectiveness of therapeutic options. However, in many cases the evidence which supports the use of these methods as opposed to traditional biochemical tests has not yet been demonstrated, and it is intended that this volume will help clarify the strengths and weaknesses of using these biomarkers across a wide range of applications and in the various organs of the body. This approach will provide pathologists, clinical biochemists and medical laboratory scientists with an invaluable overview of the diverse applications of biomarkers in medicine.

The early detection of myocardial damage is one of the major challenges in contemporary cardiology. New biochemical markers have now emerged which appear to be highly sensitive and specific for the assessment not only of patients with myocardial infarction but also of those with unstable angina and prolonged chest pains. Some of these markers, such as the troponins, have been shown to have prognostic value in the context of acute chest pain. The incorporation of novel markers of myocardial damage to the routine diagnostic armamentarium is not without difficulty. The reasons for this include cost, benefit implications and the lack of definitive comprehensive publications dealing specifically with these issues. Technical difficulties with some of the novel markers are also a problem in some cases and this issue also needs to be carefully reviewed. A critical analysis of the biochemical characteristics, sensitivity and specificity as well as the potential clinical applications of the new markers is required. This monograph addresses these issues and also sets up the basis for a redefinition of myocardial damage and myocardial infarction.The book should be of particular interest to biochemists, pharmacologists, cardiologists, general physicians and clinical and basic researchers. The important issue of myocardial damage in relation to pharmacological agents has been specifically addressed in the book and this topic should be of particular interest to both clinical pharmacologists and those working in the pharmaceutical industry.

The spectrum of unstable coronary syndromes has been the object of steadily increasing research particularly in respect of novel diagnostic and treatment modalities. Although the WHO criteria for the diagnosis of acute myocardial infarction have been known for decades, there is still much debate as to the proper use of these, especially the handling of biochemical markers. Traditional enzymes have limitations in diagnostic power and new markers have unclarified applicability with regard to standardisation of assays and decision limits. Furthermore, the growing understanding of the conception of minimal myocardial damage in the borderzone between unstable angina pectoris and myocardial infarction necessitates refinement in the definitions of the various entities within the kaleidoscope of acute myocardial ischaemia. There has been a strong impetus within the European Society of Cardiology to present this subject to a broad audience of cardiologists, and as a consequence the theme of biochemical markers has become an important constituent of the Education and Training Programmes of the Society. This book has fundamental implications for the overall comprehension of this complex area. This book on myocardial damage, compiled by international experts, will truly appeal to the basic scientist as well as the clinician searching for updated knowledge of the pathophysiology and risk stratification of unstable coronary syndromes.