ARCHIVED - Ruling out heart attacks
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May 10, 2011
Every year, some 500,000 Canadians visit emergency rooms because of chest pain. Of those, about 10 percent are diagnosed with a heart attack following an EKG while another 10-15 percent are diagnosed with a possible heart attack on the basis of a cardiac troponin test, which indicates whether cardiac tissue has been damaged.
But if the EKG and cardiac troponin tests are both negative, there is no fast way to rule out a heart attack. About 70 percent of chest pain patients are admitted to hospital for further evaluation and monitoring, more than half of whom will ultimately be discharged from hospital with a clean bill of health.
Dr. Anthony Shaw hopes to speed up the diagnostic process. In partnership with medical staff at St. Boniface Hospital in Winnipeg, he and his colleagues at the NRC Institute for Biodiagnostics are developing a new clinical test that would quickly identify people who are having a heart attack despite a negative EKG or cardiac troponin test. The test would also allow doctors to discharge people who would otherwise spend one or two days in hospital — or longer.
“We’re looking for biochemical markers that appear in someone’s blood when there is poor blood flow to their cardiac muscle, but before their heart is damaged,” explains Dr. Shaw. “In other words, their heart tissue is not receiving enough oxygen, but it isn’t dying yet.”
Forecasting the progression of kidney disease
In addition to their work on chest pain, NRC researchers are developing a diagnostic test for patients with chronic kidney disease, which by some estimates affects up to 10 percent of the population. The goal of a diagnostic test would be to forecast the rate at which someone’s kidney disease would progress if left untreated. The results would allow doctors to prescribe aggressive preventative therapy for patients who would otherwise deteriorate rapidly, while sparing the majority who remain clinically stable. Physicians want to know “which people need aggressive therapy and which ones just need to be monitored in the years ahead,” stresses Dr. Shaw.
A rapid, point-of-care diagnostic test for heart attacks could save the health-care system about $2,000 per patient, yielding annual savings of $400 million in Canada alone. Equally important is the potential to provide faster treatment for patients who require it, sparing them the loss of heart function — or worse — associated with treatment delays or misdiagnosis.
To develop a diagnostic test, Dr. Shaw and his colleagues are collecting blood samples from up to 600 patients with chest pain to follow their clinical course. “We will then look at the original samples and ask: ‘how could these samples have helped us diagnose the patients more quickly’?” The researchers are using infrared spectroscopy, magnetic resonance spectroscopy and mass spectrometry to identify any biochemical markers with diagnostic significance. They hope to complete their analysis by 2012.
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Enquiries: Media relations
National Research Council of Canada
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