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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 53, Issue 12


Cell-free DNA for diagnosing myocardial infarction: not ready for prime time

Giuseppe LippiORCID iD: http://orcid.org/0000-0001-9523-9054 / Fabian Sanchis-Gomar / Gianfranco Cervellin
Published Online: 2015-04-17 | DOI: https://doi.org/10.1515/cclm-2015-0252


A modest amount of cell-free DNA is constantly present in human blood, originating from programmed cell death, apoptosis and rupture of blood cells or pathogens. Acute or chronic cell injury contributes to enhance the pool of circulating nucleic acids, so that their assessment may be regarded as an appealing perspective for diagnosing myocardial ischemia. We performed a search in Medline, Web of Science and Scopus to identify clinical studies that investigated the concentration of cell-free DNA in patients with myocardial ischemia. Overall, eight case-control studies could be detected and reviewed. Although the concentration of cell-free DNA was found to be higher in the diseased than in the healthy population, the scenario was inconclusive due to the fact that the overall number of subjects studied was modest, the populations were unclearly defined, cases and controls were not adequately matched, the methodology for measuring the reference cardiac biomarkers was inadequately described, and the diagnostic performance of cell-free DNA was not benchmarked against highly sensitive troponin immunoassays. Several biological and technical hurdles were also identified in cell-free DNA testing, including the lack of specificity and unsuitable kinetics for early diagnosis of myocardial ischemia, the long turnaround time and low throughput, the need for specialized instrumentation and dedicated personnel, the lack of standardization or harmonization of analytical techniques, the incremental costs and the high vulnerability to preanalytical variables. Hence it seems reasonable to conclude that the analysis of cell-free DNA is not ready for prime time in diagnostics of myocardial ischemia.

Keywords: acute coronary syndrome; acute myocardial infarction; cell-free DNA; coronary heart disease; DNA; ischemic heart disease


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About the article

Corresponding author: Prof. Giuseppe Lippi, U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14, 43126 Parma, Italy, Phone: +39 0521 703050/+39 0521 703791, E-mail: , . http://orcid.org/0000-0001-9523-9054; and Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy

Received: 2015-03-12

Accepted: 2015-03-26

Published Online: 2015-04-17

Published in Print: 2015-11-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 53, Issue 12, Pages 1895–1901, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0252.

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