Evaluating the kinetics of cardiac biomarkers after ST-segment Elevation myocardial infarction.
EMERGE Research team
Cardiology Research Group
Background: Cardiac troponins are integral to the diagnosis of myocardial infarction, and plasma concentrations are used routinely in clinical practice to determine the extent of myocardial injury and to guide prognosis.(1) The latest generation of high-sensitivity assays are now able to measure very low concentrations of cardiac troponin even in healthy individuals, and as such these assay will permit a more accurate evaluation of the release and clearance of cardiac troponins from the circulation following myocardial infarction.(2)
Understanding the kinetics of cardiac biomarker release in patients with myocardial infarction will help clinicians to interpret cardiac troponins in patients who represent with recurrent symptoms, and may help us to identify patients at increased risk of adverse remodelling and subsequent heart failure.
• What factors influence the magnitude and time course of cardiac troponin release and clearance in patients with suspected or confirmed myocardial infarction
• Are there differences in troponin release kinetics between patients with ST-segment and Non-ST segment elevation myocardial infarction?
• Does the magnitude and time course of troponin release differ by age and gender?
• How does microvascular obstruction influence the release and clearance of cardiac troponin in patients undergoing percutaneous coronary intervention?
• How does the release and clearance of cardiac troponins compare to other biomarkers of myocardial injury?
• Is peak troponin concentration or a composite measure (area under the curve) a better predictor of left ventricular systolic dysfunction?
Prospective cohort study
Patients who present to the Emergency Department with suspected heart disease
Honorary Professor of Emergency Medicine & Clinical Director of the Emergency Department
Diagnostics devices play an important part in the clinical assessment of a patient’s health and treatment. The purpose of the study is the evaluation of a new diagnostic platform developed by LumiraDx. The evaluation is focused around various biomarkers useful in the emergency settings.
Collection of venous and capillary blood samples for the evaluation of new diagnostic devices for cardiovascular conditions
Prospective multicentre observational study conducted over one calendar month in 2019, with the aim of describing the epidemiology of non-trauma related headache in adults presenting to emergency departments including investigations, treatments and outcome.
This will include adult patients presenting to the ED with non-trauma-related headache as their primary complaint.
ETNA: Edinburgh Transient and Neurological attack: A Cohort Study
Patients frequently present with minor neurological symptoms where a diagnosis of transient ischaemic attack (TIA) or minor stroke is difficult to make positively or to exclude reasonably. For these patients, clinicians are uncertain whether they should: (a) reassure most patients that their symptoms are benign; (b) treat most patients with antiplatelet or other vascular prevention; or (c) stratify stroke risk further using clinical features or brain imaging.
This is important because clinical diagnosis is difficult. Mis-diagnosis is not infrequent and leads to harm from preventable recurrent stroke and costs to health systems from extra care and legal liabilities.
All ETNA participants will receive an MRI scan and the study aims to establish the feasibility and methods for a larger study of diagnostic utility of MR brain imaging and estimate the effects of MRI on clinician decision making.
This study has been recruiting in the Emergency Dept, inpatient wards and TIA clinics since August 2018. We aim to recruit 270 participants and have almost reached our target!