Allan S. Jaffe, MD, talks about the way forward for high sensitivity cardiac troponin.

Alan H.B. Wu, PhD, reviews new developments in biomarkers and LC-MS applications in clinical practice.

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Allan S. Jaffe, MD, chair of the Division of Clinical Core Laboratory Services in the Department of Laboratory Medicine and Pathology at Mayo Clinic, and a member of ET Healthcare’s Clinical Advisory Board, visited Tianjin, Qingdao, Beijing and Hangzhou recently to share his thoughts on the evolving role of high-sensitivity cardiac troponin in the diagnosis of acute myocardial infarction (AMI). He pointed out some key issues surrounding clinical application. See Figure 1. High on the agenda is consensus around the definition of a high-sensitivity cardiac troponin assay. He referred to the work of Fred S. Apple, PhD, DABCC, University of Minnesota, who proposed a framework (the Apple Score Card¹) for classifying cardiac troponin assays based on analytical performance. See Figure 2. Dr. Jaffe reminded everyone that assay results are only a part of the picture about a given patient, and the clinician is the one who makes the diagnosis.

1. Apple FS. A new season for cardiac troponin assays: it’s time to keep a score card. Clin Chem 2009;55(7):1303-1306.

Alan H. B. Wu, PhD, Professor of Medicine, University of California San Francisco School of Medicine, Chief, Clinical Chemistry Laboratory at San Francisco General Hospital, and a member of ET Healthcare’s clinical advisory board, gave a series of lectures in Shanghai and Chongqing to bring clinicians and lab professionals up to date on developments in biomarkers of heart failure and clinical applications of LC-MS/MS.

Dr. Wu highlighted the need to complement natriuretic peptides, key to diagnosis of acute dyspnea and short term risk stratification, with biomarkers for therapeutic monitoring—those focused on remodeling and fibrosis. He provided a framework for evaluating new biomarkers and suggested that galectin-3 and ST-2 appear most promising. (See Figures 1 and 2.) On clinical applications of LC-MS, he focused on four applications (vitamin D, hormones, immunosuppressants and toxicology) and explained where mass spectrometry can provide important information where existing technologies such as immunoassays cannot. For example, TOF-MS may enable presumptive detection of compounds without prior experience by the testing lab.