The Power of New Biomarkers to Detect Early Ischemia

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Presentation transcript:

The Power of New Biomarkers to Detect Early Ischemia CRT 2017, Washington, DC, USA The Power of New Biomarkers to Detect Early Ischemia Thomas F. Lüscher, FESC, FRCP Professor and Chairman Cardiology University Heart Center and Director of Molecular Cardiology, University of Zürich, Switzerland www.tomluescher.ch

Disclosure Statement of Financial Interest I, Thomas F. Luescher, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

Causes of Ischemia Lüscher TF, Templin C. Eur Heart J. 2016

Causes of Ischemia Lüscher TF, Templin C. Eur Heart J. 2016

Definition of Myocardial Infarction 1. Symptoms 2. ECG 3 Biomarkers 4. Imaging What do we need Biomarkers for? Diagnosis Infarct Size Prognosis

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

Troponins in ACS: The Guidelines

Troponins in ACS: The Guidelines Thus, troponins are the gold standard in the diagnosis of NSTEMI provided the clinical context is consistent

Troponins in ACS: The ESC Guidelines 2015: The 0/3 hour Rule-in Rule-Out Algorythm

Troponins in ACS: The ESC Guidelines 2015 The 0/1 hour Rule-in Rule-Out Algorythm

Troponins in ACS: The Evidence for the 0/1 hour Rule-in Rule-Out Algorythm

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

Targeting inflammatory pathways for the treatment of cardiovascular disease Targeting inflammatory pathways for the treatment of cardiovascular disease. Abbreviations: CCR2/CCR5, chemokine receptor types 2 and 5; CRP, C-reactive protein; FLAP, 5-liopoxygenase-activating protein; hsCRP, high-sensitivity C-reactive protein; ICAM-1, intercellular adhesion molecule type 1; IL-1b, interleukin-1b; IL-18, interleukin-18; IL-6, interleukin-6; 5-LO, 5-lipoxygenase; Lp-PLA2, lipoprotein-associated phospholipase A2; MMP-9, matirx metalloproteinase-9; PAI-1, plasminogen activator inhibitor type-1; SAA, serum amyloid A; SIRT1, sirtuin-1; sPLA2, secretory phospholipse A2; TNF-a, tumour necrosis factor-a; and VCAM, vascular cellular adhesion molecule. P. Ridker. Eur. Heart J. 2014;35: 540

Inflammatory Markers in Stable CAD and ACS Maier, Altwegg et al. Circulation 2005

Interleukin-6 and serum amyloid A levels at the site of coronary occlusion and in the peripheral blood

Evolving Acute Myocardial Infarction Inflammation, Plaque Destabilisation Plaque Rupture, Coronary Occlusion C-reactive protein Interleukin-1b Interleukin-6 Other cytokines Troponins Creatinin kinases Myoglobin

The Power of New Biomarkers to Detect Early Ischemia Definition of Myocardial Infarction Diagnostic Value of Biomarkers Prognostic Value of Biomarkers Novel Biomarkers for CV Patients Conclusion

The Power of New Biomarkers to Detect Early Ischemia High-sensitive troponins are the gold standard for the detection of ischemia They provide early information for diagnosis and risk stratification of ACS Novel biomarkers of inflammation and thrombus formation hold promise for even earlier detection of patients at risk Thank You!