Morrow Cardiovascular Biomarkers

Pathophysiology and Disease Management
1. Auflage 2010
ISBN: 978-1-59745-051-5
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 640 Seiten

Reihe: Contemporary Cardiology

In the four pages committed to a discussion of myocardial infarction in the first edition of Harrison's Principles of Internal Medicine, published in 1950, there was no mention of use of the laboratory for management of patients. Thirty years later, when the first edition of Braunwald's Heart Disease, A Textbook of Cardiovascular Medicine was published, 2 out of the 1943 pages in the text contained a discussion of the laboratory examinations in acute myocardial infarction. Our knowledge base of the multitude of ways that physicians can and should use the clinical chemistry laboratory has expanded dramatically since these classic texts were published. The nomenclature has changed: terms such as 'cardiac enzymes' have given way to 'cardiac biomarkers. ' The number of assays has multiplied, and the operating characteristics of available assays are impr- ing at a gratifying but dizzying rate. We now use biomarkers to diagnose cardiovascular diseases and also to frame our treatment strategies. Thus, there is a clear need for a scholarly compilation of the state of the art of cardiac biomarkers. Dr. David Morrow has expertly edited an authoritative book that answers this need. The 34 chapters in Cardiovascular Biomarkers: Pathophysiology and Disease Mana- ment were written by a group of individuals who are internationally recognized thought leaders and experts in clinical and laboratory medicine.

Autoren/Hrsg.

Morrow, David A.

Leseproben

"26 Clinical and Research Applications of Markers of Thrombosis (p. 451-452)

SUMMARY

We provide a brief overview of vascular thrombosis as applied to the arterial circulatory system. This background serves as a template for understanding potential biomarkers of thrombosis. Additionally, the integrated relationship between genotype and phenotypic expression of disease, measurable as circulating (soluble) proteins and cell-based products, including fibrinogen, thrombin, thrombomodulin, tissue factor, tissue factor pathway inhibitor, platelet surface markers, and others, is highlighted. Finally, the role of endothelial cell and endothelial cell-surface markers as biomarkers of thrombosis is discussed. As applicable, the clinical and potential research applications of specific biomarkers of thrombosis are provided.

Key Words: Thrombosis; biomarker; coagulation; endothelial cell.

INTRODUCTION

Hemostasis is the physiological process that maintains blood in a fluid state within circulation (2). Under normal physiological circumstances, blood components do not interact with an intact vascular endothelium. Arterial thrombosis, like venous thrombosis, as described by Virchow, occurs when there is alteration in blood flow, change in the hemostatic protein composition of blood, or change in the vessel wall. The activation of coagulation leads to a series of cell-surface-based events that result in the activation of multiple proteins.

These proteins not only function to increase the clotting ability of blood, but they simultaneously activate anticoagulant processes as well. In this manner, the exquisite balance of hemostasis is restored with both thrombin and fibrin generation and degradation all occurring at any given moment. Thrombosis within the coronary vascular bed is a dynamic process, with clot formation and dissolution occurring simultaneously at many sites.

Occlusive thrombus and circulatory compromise occur when there is a shift in the balance between these processes (1). Recent advances in understanding the pathobiology of atherothrombosis have demonstrated a finely orchestrated interplay among inflammation, thrombosis, and oxidative stress. As the fundamental properties of atherogenesis, endothelial cell injury/dysfunction, plaque metamorphosis, and thrombogenesis are elucidated, measurable biological markers representing the natural history of disease that can be used for diagnosis, risk assessment, and the management of patients with coronary atherothrombosis are likely to emerge."