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The International Federation of Clinical Chemistry and Laboarator Medicine (IFCC) Committee on Clinical Applications of Cardiac Bio-Markers (C-CB) has provided evidence-based educational resources to aid and improve the understanding of important analytical and clinical aspects of cardiac biomarkers. The present IFCC C-CB educational report focuses on recommendations for appropriate use, analytical performance, and gaps in clinical studies related to the use of cardiac troponin (cTn) by point of care (POC) measurement, often referred to as a point of care testing (POCT). The use of high-sensitivity (hs)-cTn POC devices in accelerated diagnostic protocols used in emergency departments or outpatient clinics investigating acute coronary syndrome has the potential for improved efficacy, reduction of length of stay and reduced costs in the health care system. POCT workflow integration includes location of the instrument, assignment of collection and testing responsibility to (non-lab) staff, instrument maintenance, in-service and recurrent training, quality control, proficiency assessments, discrepant result trapping, and troubleshooting and inventory management. [ABSTRACT FROM AUTHOR]

Sample analysis All serum samples were tested in duplicate on the Erenna SP ® sp platform by EMD Millipore Corporation, Hayward California. However, our CV SB A sb % was obtained from duplicates with median cMyC of 4.38 (2.75-5.97) ng/L, which is considerably lower than median cMyC found in patient with adjudicated diagnosis of acute coronary syndrome 237 (71-876) ng/L in the APACE cohort [[6]], and only ~5% of the 99th percentile (derived from patients without coronary artery disease) [[28]]. Analysis, confined to the initial presentation blood sample, showed that cMyC is at least as good as cardiac troponin measured with the leading assays in predicting the diagnosis of AMI, mortality and future cardiovascular events [[6]]. Keywords: biological variation; cardiac myosin-binding protein C; index of individuality; reference change value EN biological variation cardiac myosin-binding protein C index of individuality reference change value 576 583 8 03/11/22 20220301 NES 220301 Introduction Cardiac myosin-binding protein C (cMyC) is a novel biomarker of myocardial injury that was first identified in cardiac venous effluent approximately 10 years ago [[1]]. [Extracted from the article]

• Analytical performance specifications for hs-cTn assays should be based clinical use. • Outcome studies suggest performance is sufficient for rapid identification of NSTEMI. • Biological variation may guide performance when hs-cTn are used for risk prediction. • Further improvement in analytical performance is likely to be clinically useful. Concurrent with the introduction of cardiac troponin measurements into the diagnostic definition of myocardial infarction (MI), clinicians and laboratory professionals signaled a clear clinical need for improved analytical quality. This was an important precipitant for developing high-sensitivity cardiac troponin (hs-cTn) assays, currently used in rapid algorithms guiding investigations of patients presenting to the emergency department with possible MI. The hs-cTn assays were also important for the detection and monitoring of low-grade chronic myocardial injury, a condition that has been linked to increased long-term risk of cardiovascular morbidity and mortality. This review summarizes the general recommendations for defining analytical performance specifications while providing relevant clinical situations related to analytical performance. Importantly, outcome studies suggest analytical quality performance for hs-cTn is sufficient for early discharge of patients investigated for possible MI. However, bias due to change in calibrators or reagents may significantly affect the percentage of patients discharged. Biological variation data is suitable for defining performance specifications when hs-cTn measurements are used for diagnosing and monitoring chronic myocardial injury. Further improvement in analytical performance for hs-cTn testing may result in even faster decision making in the emergency setting; while also identifying those with chronic injury at risk for an adverse cardiac event. [ABSTRACT FROM AUTHOR]

Background Copeptin concentrations increase both during acute coronary syndrome and following physical exercise. The relationship between copeptin increase following physical exercise and coronary artery disease (CAD) is uncertain. The aim of this study was to 1) describe the copeptin response following strenuous physical exercise, and 2) investigate the determinants of exercise induced copeptin concentrations, particularly in relation to cardiac biomarkers and CAD. Methods Serum samples were collected from 97 recreational cyclists 24 h before, and immediately, 3 and 24 h after a 91-km bike race. Three subjects were subsequently diagnosed with significant asymptomatic CAD. Delta copeptin concentrations were correlated to patient characteristics and to biomarker concentrations. Results Participants were 42.8 ± 9.6 years, and 76.3% were male. Copeptin concentrations increased to maximal levels immediately after the race and were normalized in > 90% after 3 h. A total of 53% and 39% exceeded the 95th and 99th percentile of the assay (10 and 19 pmol/L) respectively. In multivariate models, race time, serum sodium, creatinine and cortisol were significant predictors of copeptin levels. There was no correlation between changes in copeptin and changes in cardiac biomarkers (hs-cTnI, hs-cTnT and BNP). Copeptin concentrations were normal in the subjects with asymptomatic CAD. Conclusions The moderate, short-term, exercise induced copeptin increase observed in the present study was not related to hs-cTn or BNP levels. Copeptin was normal in three asymptomatic recreational athletes with significant CAD. [ABSTRACT FROM AUTHOR]