The Echo system makes the data tighter and reduces the day to day variation.

Susan Daniels

VP of Development, CARDIODX

Cardiovascular Genomics Innovator Improves Testing Process with the Echo® Liquid Handler

Coronary artery disease (CAD) is the number one cause of death for both men and women in the United States. Typically, a clinician will use a variety of evaluation tools — both functional and imaging technologies — to determine the presence of significant blockages in the heart arteries also known as obstructive CAD*. Diagnosing the disease in female patients, however, remains a challenge because symptoms of obstructive CAD are often less obvious in women than in men. Most common tests do not account for the cardiovascular differences between men and women, making them less effective for female patients. The current gold standard diagnostic method is an invasive cardiac procedure that involves radiation exposure called coronary angiography.

Echo 555 Liquid Handler

To address the need for a simple, gender-specific tool to provide sensitive, non-invasive assessment of obstructive CAD without using radiation, CardioDx, Inc. — a molecular diagnostics company specializing in cardiovascular disease — introduced the Corus® CAD test in 2009.

The Corus CAD test helps clinicians determine whether a patient’s chest pain and related symptoms are due to a blocked artery in the heart. The test is processed at the company’s CLIA-certified and CAP-accredited clinical laboratory lab in Redwood City. The test integrates information about the patient’s age, sex, and gene expression to calculate a score, which has been demonstrated in clinical studies to help clinicians accurately rule-out obstructive CAD as the cause of their patients’ symptoms. With this information, the clinician can make a more informed decision about the next course of action, and potentially avoid subjecting their patients to unnecessary and invasive cardiac procedures.

To improve its processing of these samples, CardioDx uses the Echo Liquid Handler in both its clinical and its R&D labs.

“Since we launched the test, we’ve been focused on making the process in our laboratory streamlined, higher throughput and lowering the cost, while keeping the same quality of data,” explains Susan Daniels, Vice President of Development.

Daniels and her team keep their lab at the cutting edge by frequently evaluating new technologies. “We look to see where the next bottlenecks are going to be in our processes as sample volume increases, and resolve these before they hit the lab,” she says. “When we identify areas in the processing where those bottlenecks are going to occur, we’ll focus in on that particular piece of the process and proactively look to see what new solutions are out there.”

The Echo has taken a process that would take six hours down to one hour. The Echo system makes the data tighter and reduces the day to day variation seen in the daily processing for us.

Susan Daniels|Vice President of Development

A Better Solution for Liquid Handling

As the company scaled up operations, it sought a better solution for liquid handling and selected the Echo system because of its speed, accuracy, and ease of use.

With its underlying acoustic technology, the Echo liquid handler provides a much quicker process for CardioDx to load patient samples onto the PCR plates they use to generate gene expression results, which translates into real cost savings. “The Echo has taken a process that would take six hours down to one hour. It’s really helped facilitate the process of taking the patient samples through to generating gene expression data,” Daniels explains.

Beyond speed, CardioDx was impressed with the system’s accuracy and reproducibility, which also helps the lab save money, says Daniels. “The Echo system makes the data tighter and reduces the day to day variation seen in the daily processing for us. That was a great benefit of moving to this technology; it reduces the number of patients we have to repeat,” she says.

User friendliness is another benefit, “The feedback we get from the lab is that they like the ease-of-use of the instrument,” Daniels says. “It’s simple.”

Beyond how they are using the system now, Daniels anticipates that they could expand their use of the Echo for other workflow benefits. “We could use it to do additional steps, such as adding the real-time PCR reagents to the 384-well plates, not just for the patient samples,” she notes. “I’d like to see us using the Echo in additional steps in the process.”

What has been good for business has also been good for the earth. “In this day and age, the ability to move liquids without plastic ware is huge — not just cost-wise but also for the environment,” she says.

*Obstructive CAD is defined as at least one atherosclerotic plaque causing ≥50% luminal diameter stenosis in a major coronary artery (≥1.5 mm lumen diameter) as determined by invasive quantitative coronary angiography or coronary computed tomography angiography (≥2.0 mm lumen diameter).

iCenters for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program: Accessed on Feb 3, 2015.