Cardiovascular

Cardiovascular diseases encompass a wide range of conditions including heart attack, heart failure, thrombosis, pulmonary embolism, and aneurysm. Laboratory testing provides important information about heart and blood vessel health through various tests. These data help assess cardiovascular disease risk, diagnose heart or vascular conditions, choose appropriate treatment, and monitor therapy.

In vitro diagnostics

Examples illustrate the added value of laboratory tests in detecting, diagnosing, monitoring, and treating cardiovascular diseases.

In vitro diagnostics

• Heart attack

  During a heart attack, a coronary artery becomes blocked, causing oxygen deficiency in (parts of) the heart. This leads to heart tissue damage, causing substances to be released from affected heart cells into the blood. These include troponin and creatine kinase (CK-MB), two characteristic heart proteins. Both are used to diagnose a heart attack.

  Troponin test

  Troponin is a protein that normally enables heart muscle contraction. When the heart and heart tissue are healthy, blood troponin levels are low. During a heart attack, troponin is released. This becomes measurable in the blood after three hours and remains elevated for two weeks after the heart attack. The troponin test is used to diagnose heart attacks in people who arrive at Emergency Cardiac Care (ECC) with chest pain. However, only about twenty percent of these patients actually have a heart attack. To prevent unnecessary ECC referrals, the test is now available as a high-sensitivity troponin point-of-care test. This highly sensitive test can determine troponin levels at the patient's location. Combined with a risk score, the healthcare provider can immediately decide whether someone with chest pain needs to be admitted.

  CK-MB test

  Creatine kinase (CK) is an enzyme that plays an important role in cellular energy supply in the heart, brain, and muscles. CK-MB is a form of an enzyme primarily found in heart muscle. It is released when heart tissue is damaged. In an acute heart attack, CK-MB becomes measurable in the blood after three to six hours. Peak values are reached after twelve to twenty hours. After that, values return to normal. The CK-MB test is less specific than the troponin test.

• Heart failure

  In heart failure, the heart doesn't pump blood effectively, causing organs and muscles to receive insufficient oxygen and nutrients. Early detection of heart failure is very important. While the condition cannot be cured, treatment options are available. Heart failure can be detected through a blood test that measures two specific proteins: BNP and NT-proBNP, both indicating poor heart pump function.

  BNP and NT-proBNP

  When the heart muscle experiences increased stress, BNP (Brain-type Natriuretic Peptide) is released from heart muscle cells. BNP causes blood vessels to dilate, reducing the heart strain. Along with BNP, the physiologically inactive byproduct NT-proBNP is also released. Blood levels of both compounds provide insight into heart failure (severity). Because multiple causes can lead to elevated BNP and NT-proBNP, this test's strength lies primarily in ruling out heart failure when there is strong clinical suspicion of the condition. The test is also suitable for following up medication effects (monitoring) and estimating heart failure risk (prognosis).

• Thrombosis

  In thrombosis, a blood vessel becomes blocked by a blood clot. When the clot blocks a vein, it's called venous thromboembolism (VTE). This often occurs in the legs (deep vein thrombosis). A clot can break off and travel to the lungs (pulmonary embolism). Deep vein thrombosis (DVT) occurs in the deeper veins.

  D-dimer test

  Diagnosing thrombosis can be challenging. Along with ultrasound and imaging diagnostics, blood testing plays a complementary role through the D-dimer test. D-dimers are released during blood clot breakdown. When these compounds are detected in the blood, it indicates the presence (current or recent) of a clot. The D-dimer test is quick and simple but not specific. A positive result requires follow-up testing to confirm venous thromboembolism (VTE); a negative result can rule out VTE. With a point-of-care D-dimer test, primary care physicians can rule out VTE when thrombosis is suspected.

  Blood coagulation test

  Patients with an increased risk of thrombosis are treated with anticoagulants (blood thinners). Dosing requires precise monitoring: too much anticoagulant increases the risk of severe bleeding, too little leads to blood clots. Monitoring blood coagulation status is crucial for proper dose adjustment. Blood clotting time can be determined using the PT test (prothrombin time) and/or the APTT test (activated partial thromboplastin time). Anticoagulation medication can be adjusted based on test results. The test is also available as a home test, allowing patients to monitor their blood coagulation values and adjust medication themselves.

• Blood Gas Analysis

  Blood gas analysis measures parameters that are essential for assessing respiratory function and acid–base balance. These parameters include oxygen (pO₂), carbon dioxide (pCO₂), pH, and CO-oximetry. Modern point-of-care blood gas analyzers also enable the measurement of electrolytes such as sodium, potassium, and calcium, as well as metabolites including lactate and glucose, from the same blood sample.

  The combined interpretation of blood gases, electrolytes, and metabolites supports rapid diagnosis and clinical decision-making in acute conditions, including respiratory failure, shock, sepsis, and severe metabolic disturbances. These measurements are particularly important in acute care settings, where they contribute to timely diagnosis and appropriate treatment.

   

  The Importance of Hemolysis Detection

  Hemolysis, the breakdown of red blood cells, accounts for approximately 70% of all pre-analytical errors and has a significant impact on blood gas analysis results. Potassium (K⁺) measurements are particularly susceptible because large amounts of intracellular potassium are released when red blood cells break down. This can result in falsely elevated potassium values, potentially leading to inappropriate or delayed treatment.

  To prevent this, in-line hemolysis detection is performed. This technology measures the concentration of free hemoglobin in whole blood and, within 45 seconds, indicates whether hemolysis is present and, if so, to what extent. When the hemolysis threshold is exceeded, the potassium result is flagged as unreliable or suppressed.

  Timely and accurate hemolysis detection supports rapid and informed clinical decision-making in acute care settings. This helps ensure accurate diagnosis, appropriate treatment, improved patient outcomes, and more efficient, cost-effective healthcare.

   

• Hemostasis

  Hemostasis is the body's natural physiological process for preventing or stopping bleeding. It relies on a carefully balanced interplay between coagulation factors and anticoagulation factors in the blood. Disorders of hemostasis can result in either bleeding (hemorrhage) or the formation of blood clots (thrombosis).

  During extensive medical procedures or complications following childbirth or trauma, accurate assessment of hemostasis is crucial for identification and effective management of uncontrolled bleeding. Fibrinogen, the precursor of the fibrin clot, is a valuable blood biomarker for assessing the coagulation pathway. When fibrinogen levels are too low, adequate clot formation cannot occur, significantly increasing the risk of uncontrolled bleeding. Fibrinogen testing can be used when an increased bleeding risk is suspected or for monitoring complex coagulation disorders.

   

  Rapid Fibrinogen Test

  The gold standard for measuring fibrinogen is the von Clauss clotting assay. However, this laboratory test is time-consuming and is logistically complex. A point-of-care (POC) test offers a rapid and accurate alternative.

  A few drops of blood are mixed with reagents in a disposable test cartridge, converting fibrinogen in the blood sample into fibrin. The amount of fibrin (clot) formed is then measured using optical detection. The result of this rapid fibrinogen test is available within minutes, enabling accurate identification of unwanted or unexpected bleeding. This facilitates faster initiation of appropriate therapy while minimizing the risk of under- or overtreatment. Ultimately, this contributes to a lower incidence of bleeding-related complications and, consequently, reduced healthcare costs.

   

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