ROLE OF ISCHEMIA MODIFIED ALBUMIN IN THE EARLY DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION.

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V. D and G. B, “ROLE OF ISCHEMIA MODIFIED ALBUMIN IN THE EARLY DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION”., ijmhs, vol. 4, no. 1, Feb. 2014.
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Abstract

Abstract:

The primary aim of this study was to investigate serum Ischemia Modified Albumin (IMA) as a useful marker in the early diagnosis of Acute myocardial infarction (AMI). A total of 144 patients admitted in the Intensive care unit of PSG Hospitals with suspected AMI and 73 healthy control subjects were enrolled in this observational study. 24 patients were excluded. Serum cTnT was estimated by a fully automated Immunodiagnostics analyzer ROCHE Elecsys 2010. IMA was estimated by a spectrophotometric method as described byBar Or et al. The diagnostic sensitivity of the two markers were analysed using students ‘t’ test. Patients were divided into the AMI group (n = 104), the unstable angina group (n=10) and the non-ischemic chest pain group (n = 06), according to the ECG results.  Mean IMA values were higher in AMI group (p <0.00001) and in patients with Unstable Angina (UA) (p <0.005) compared with control. The diagnostic sensitivity of IMA was higher than cTnT in STEMI (100% vs 68%), NSTEMI ( 97% vs 44%) and in unstable angina(100% vs 0%) . In UA the cTnT levels remained below the cutoff level (<0.03 ng/mL). The increase in IMA levels was noted within minutes after the onset of symptoms and remained elevated after 6 hrs. The cTnT levels were below the cutoff levels in UA, whereas the IMA levels are elevated significantly (p <0.005) compared to controls.We have shown that IMA is a potential diagnostic biomarkerfor UA than cTnT and assessment of serum IMA in patients with chest pain will improve current diagnostic strategies foracute chest pain patients to avoid adverse cardiac events.

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References

[1] Chawla R., Navendu Goyal,Rajneesh Calton and Shweta Goyal , “Ischemia Modified Albumin : A novel Marker for Acute Coronary Syndrome”. Indian Journal of Clinical Biochemistry, 2006; 21(1) 77-82. [2] Greenlund KJ, Giles WH, Keenan NL, et al. Heart disease and stroke mortality in the 20th century. In: Ward J, Warren C, eds. Silent victories: the history and practice of public health in twentieth century America; 2006. [3] Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics.2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2006;113:69-171. [4]Prevalence of Heart Disease - United States. 2007;56 (06):113-118. [5] Auxter, Sue (2003).Cardiac Ischemia Testing: A new era in chest pain evaluation. Clin. Lab. News, 29,1-3. [6] Kontos, M.C. and Jesse, R.L. (2000). Evaluation of the emergency Dept. Chest pain patient. Am.J.Cardiol, 85,32B-39B. [7] Gomez, M.A., Anderson, J.L., Karagounis L. A., Muhlestein, J. B. and Mooers, F. B. (1996). An emergency medicine based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense. Results of randomized study (ROMO). J. Am. Coll. Cardiol, 28: 25-33. [8] Tsakiris AK, Marnelos PG, Nearchou NS, Papadakis JE, Karatzis EN, Skoufas PD. The influence of thrombolytic therapy on C-reactive protein in ST- segment elevation AMI. Hellenic J Cardiol, 2006;47:218-222. [9] Mc Cord J. Oxygen-derived free radicals in post ischemic tissue injury. N Engl J Med, 1985; 312:159-163. [10] Chan B, Dodsworth N, Woodrow J, Tucker A, Harris R. Site-specific N-terminal auto degradation of human serum albumin. Eur J Biochem, 1995;227:524-528. [11] Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker Ischemia modified albumin. Heart, 2006; 92:113-114. [12] Bar-Or D, Lau E, Winkler JV. A novel assay for Cobalt-Albumin binding and its potential as a marker for myocardial ischemia- A preliminary report. J Emerg Med, 2000; 19:311-315. [13] Eftihia Sbarouni, Panagiota Georgiadou, Dimitrios-TH. Kremastinos, Vasilios Voudris. Ischemia Modified Albumin: Is this Marker of Ischemia ready for prime time use? Hellenic J Cardiol, 2008; 49:260-266. [14] Bar-Or D, Lau E, Winkler JV, Vanbenthuysen K, Harris L, Hetzel FW. Reduced Albumin Cobalt Binding with transient Myocardial Ischemia after elective percutaneous transluminal coronary angioplasty: A preliminary comparison to CK-MB, Myoglobin and Troponin I. Am Heart J, 2001; 141:985-991. [15] Sinha NK, Gaze DC, Tippins JR, Collinson PO, kaski JC. IMA is a sensitive marker of Myocardial Ischemia after percutaneous coronary intervention. Circulation, 2003; 107:2403-2405. [16] Bar Or, D.,Lau, E. Rao, N., Bampos, N.,Winkler, J. V. and Curtis, C. G. Reduction in the Cobalt Binding capacity of Human Albumin with Myocardial Ischemia. Ann. Emerg. Med, 1999;34:556 [17] Goldman L, Weinberg M, Weisberg M, et al. A computer derived protocol to aid in the diagnosis of ER patients with acute chest pain. N Engl J Med, 1982;307:588-96. [18] Selker HP, Beshansky JR, Griffith JL, et al. Use of the acute cardiac ischemia time insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicentre, controlled clinical trial. Ann Intern Med, 1998; 129:845-55. [19] Einstein AJ, Bodiam CA, Gill J. The relationships among performance measures in selection of diagnostic tests. Arch Pathol Lab Med, 1997;121:110-17. [20] Quiles J, Roy D, Gaze D, et al. Relation of ischemia-modified albumin (IMA) levels following elective angioplasty for stable angina pectoris to duration of balloon-induced myocardial ischemia. Am J Cardiol, 2003; 92: 322-324. [21] Garrido IP, Roy D, Calvino R, et al. Comparison of ischemia modified albumin levels in patients undergoing percutaneous coronary intervention for unstable angina pectoris with versus without collaterals. Am J Cardiol, 2004; 93: 88-90. [22] Sinha MK, Vazquez JM, Calvino R, Gaze DC, Collinson PO, Kaski JC. Effects of balloon occlusion during percutaneous coronary intervention on circulating ischemia modified albumin and transmyocardial lactate extraction. Heart, 2006; 92: 1852-1853. [23] Apple FS, Quist HE, Otto AP, Mathews WE, Murakami MM. Release characteristics of cardiac biomarkers and ischemiamodified albumin as measured by the albumin cobalt-binding test after a marathon race. Clin Chem, 2002; 48: 1097-1100.

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References

[1] Chawla R., Navendu Goyal,Rajneesh Calton and Shweta Goyal , “Ischemia Modified Albumin : A novel Marker for Acute Coronary Syndrome”. Indian Journal of Clinical Biochemistry, 2006; 21(1) 77-82.
[2] Greenlund KJ, Giles WH, Keenan NL, et al. Heart disease and stroke mortality in the 20th century. In: Ward J, Warren C, eds. Silent victories: the history and practice of public health in twentieth century America; 2006.
[3] Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics.2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2006;113:69-171.
[4]Prevalence of Heart Disease - United States. 2007;56 (06):113-118.
[5] Auxter, Sue (2003).Cardiac Ischemia Testing: A new era in chest pain evaluation. Clin. Lab. News, 29,1-3.
[6] Kontos, M.C. and Jesse, R.L. (2000). Evaluation of the emergency Dept. Chest pain patient. Am.J.Cardiol, 85,32B-39B.
[7] Gomez, M.A., Anderson, J.L., Karagounis L. A., Muhlestein, J. B. and Mooers, F. B. (1996). An emergency medicine based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense. Results of randomized study (ROMO). J. Am. Coll. Cardiol, 28: 25-33.
[8] Tsakiris AK, Marnelos PG, Nearchou NS, Papadakis JE, Karatzis EN, Skoufas PD. The influence of thrombolytic therapy on C-reactive protein in ST- segment elevation AMI. Hellenic J Cardiol, 2006;47:218-222.
[9] Mc Cord J. Oxygen-derived free radicals in post ischemic tissue injury. N Engl J Med, 1985; 312:159-163.
[10] Chan B, Dodsworth N, Woodrow J, Tucker A, Harris R. Site-specific N-terminal auto degradation of human serum albumin. Eur J Biochem, 1995;227:524-528.
[11] Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker Ischemia modified albumin. Heart, 2006; 92:113-114.
[12] Bar-Or D, Lau E, Winkler JV. A novel assay for Cobalt-Albumin binding and its potential as a marker for myocardial ischemia- A preliminary report. J Emerg Med, 2000; 19:311-315.
[13] Eftihia Sbarouni, Panagiota Georgiadou, Dimitrios-TH. Kremastinos, Vasilios Voudris. Ischemia Modified Albumin: Is this Marker of Ischemia ready for prime time use? Hellenic J Cardiol, 2008; 49:260-266.
[14] Bar-Or D, Lau E, Winkler JV, Vanbenthuysen K, Harris L, Hetzel FW. Reduced Albumin Cobalt Binding with transient Myocardial Ischemia after elective percutaneous transluminal coronary angioplasty: A preliminary comparison to CK-MB, Myoglobin and Troponin I. Am Heart J, 2001; 141:985-991.
[15] Sinha NK, Gaze DC, Tippins JR, Collinson PO, kaski JC. IMA is a sensitive marker of Myocardial Ischemia after percutaneous coronary intervention. Circulation, 2003; 107:2403-2405.
[16] Bar Or, D.,Lau, E. Rao, N., Bampos, N.,Winkler, J. V. and Curtis, C. G. Reduction in the Cobalt Binding capacity of Human Albumin with Myocardial Ischemia. Ann. Emerg. Med, 1999;34:556
[17] Goldman L, Weinberg M, Weisberg M, et al. A computer derived protocol to aid in the diagnosis of ER patients with acute chest pain. N Engl J Med, 1982;307:588-96.
[18] Selker HP, Beshansky JR, Griffith JL, et al. Use of the acute cardiac ischemia time insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicentre, controlled clinical trial. Ann Intern Med, 1998; 129:845-55.
[19] Einstein AJ, Bodiam CA, Gill J. The relationships among performance measures in selection of diagnostic tests. Arch Pathol Lab Med, 1997;121:110-17.
[20] Quiles J, Roy D, Gaze D, et al. Relation of ischemia-modified albumin (IMA) levels following elective angioplasty for stable angina pectoris to duration of balloon-induced myocardial ischemia. Am J Cardiol, 2003; 92: 322-324.
[21] Garrido IP, Roy D, Calvino R, et al. Comparison of ischemia modified albumin levels in patients undergoing percutaneous coronary intervention for unstable angina pectoris with versus without collaterals. Am J Cardiol, 2004; 93: 88-90.
[22] Sinha MK, Vazquez JM, Calvino R, Gaze DC, Collinson PO, Kaski JC. Effects of balloon occlusion during percutaneous coronary intervention on circulating ischemia modified albumin and transmyocardial lactate extraction. Heart, 2006; 92: 1852-1853.
[23] Apple FS, Quist HE, Otto AP, Mathews WE, Murakami MM. Release characteristics of cardiac biomarkers and ischemiamodified albumin as measured by the albumin cobalt-binding test after a marathon race. Clin Chem, 2002; 48: 1097-1100.

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