Theodore Pipikos1, Alkistis Kapelouzou2, Diamantis I Tsilimigras3, Yannis Fostinis1, Marina Pipikou1, Athanassios Theodorakos1, Antonis N Pavlidis4, Christos Kontogiannis3, Dennis V Cokkinos5, Maria Koutelou1. 1. Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece. 2. Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Str., 11527, Athens, Greece. akapel@bioacademy.gr. 3. School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 4. Department of Cardiology, Guy's and St. Thomas', NHS Foundation Trust, London, UK. 5. Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Str., 11527, Athens, Greece.
Abstract
BACKGROUND: Acute myocardial infarction (AMI) is considered a major cause of death and disability. Myocardial perfusion scintigraphy (MPS) as a non-invasive diagnostic imaging procedure and certain biomarkers associated with myocardial ischemia (ISCH), such as ischemia-modified albumin (IMA), neuropeptide Y (NPY), N-terminal pro b-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) could probably aid in the detection of myocardial infarction. METHODS: Between December 2011 and June 2012, we prospectively analyzed patients who underwent a MPS study with the clinical question of myocardial ISCH. An exercise test was performed along with a MPS. Blood was drawn from the patients before exercise and the within 3 minutes from achieving maximum load and was analyzed for the aforementioned biomarkers. RESULTS: A total of 71 patients (56 men and 15 women) were enrolled with a mean age of 61 ± 12 years. Twenty-six patients (36.6%) showed reduced uptake on stress MPS images that normalized at rest, a finding consistent with ISCH. Between ISCH and non-ISCH groups, only hsTnT levels showed a significant difference with the highest levels pertaining to the former group both before (0.0075 ng/ml vs 0.0050 ng/ml, P = 0.023) and after stress exercise (0.0085 vs 0.0050, P = 0.015). The most prominent differences were seen in higher stages of the Bruce protocol (stress duration > 9.05 minutes - P < 0.017). None of the IMA, NPY, and NP-pro BNP showed significant differences in time between the two groups. CONCLUSIONS: Although IMA, NPY, and NT-pro BNP may not detect minor ischemic myocardial insults, serum hsTnT holds a greater ability of detecting not only myocardial infarction but also less severe ischemia. Further studies with larger cohorts of patients are warranted in order to better define the role of hsTnT as a screening tool for myocardial ischemia.
BACKGROUND: Acute myocardial infarction (AMI) is considered a major cause of death and disability. Myocardial perfusion scintigraphy (MPS) as a non-invasive diagnostic imaging procedure and certain biomarkers associated with myocardial ischemia (ISCH), such as ischemia-modified albumin (IMA), neuropeptide Y (NPY), N-terminal pro b-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) could probably aid in the detection of myocardial infarction. METHODS: Between December 2011 and June 2012, we prospectively analyzed patients who underwent a MPS study with the clinical question of myocardial ISCH. An exercise test was performed along with a MPS. Blood was drawn from the patients before exercise and the within 3 minutes from achieving maximum load and was analyzed for the aforementioned biomarkers. RESULTS: A total of 71 patients (56 men and 15 women) were enrolled with a mean age of 61 ± 12 years. Twenty-six patients (36.6%) showed reduced uptake on stress MPS images that normalized at rest, a finding consistent with ISCH. Between ISCH and non-ISCH groups, only hsTnT levels showed a significant difference with the highest levels pertaining to the former group both before (0.0075 ng/ml vs 0.0050 ng/ml, P = 0.023) and after stress exercise (0.0085 vs 0.0050, P = 0.015). The most prominent differences were seen in higher stages of the Bruce protocol (stress duration > 9.05 minutes - P < 0.017). None of the IMA, NPY, and NP-pro BNP showed significant differences in time between the two groups. CONCLUSIONS: Although IMA, NPY, and NT-pro BNP may not detect minor ischemic myocardial insults, serum hsTnT holds a greater ability of detecting not only myocardial infarction but also less severe ischemia. Further studies with larger cohorts of patients are warranted in order to better define the role of hsTnT as a screening tool for myocardial ischemia.
Authors: Hani Jneid; Jeffrey L Anderson; R Scott Wright; Cynthia D Adams; Charles R Bridges; Donald E Casey; Steven M Ettinger; Francis M Fesmire; Theodore G Ganiats; A Michael Lincoff; Eric D Peterson; George J Philippides; Pierre Theroux; Nanette K Wenger; James Patrick Zidar; Jeffrey L Anderson Journal: Circulation Date: 2012-07-16 Impact factor: 29.690
Authors: D A Morrow; E M Antman; A Charlesworth; R Cairns; S A Murphy; J A de Lemos; R P Giugliano; C H McCabe; E Braunwald Journal: Circulation Date: 2000-10-24 Impact factor: 29.690
Authors: Hein J Verberne; Wanda Acampa; Constantinos Anagnostopoulos; Jim Ballinger; Frank Bengel; Pieter De Bondt; Ronny R Buechel; Alberto Cuocolo; Berthe L F van Eck-Smit; Albert Flotats; Marcus Hacker; Cecilia Hindorf; Philip A Kaufmann; Oliver Lindner; Michael Ljungberg; Markus Lonsdale; Alain Manrique; David Minarik; Arthur J H A Scholte; Riemer H J A Slart; Elin Trägårdh; Tim C de Wit; Birger Hesse Journal: Eur J Nucl Med Mol Imaging Date: 2015-08-21 Impact factor: 9.236