Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
Int J Cardiol. 2013 Jul 31;167(2):531-6. doi: 10.1016/j.ijcard.2012.01.075. Epub 2012 Feb 12.
Geriatric patients with acute non-ST elevation myocardial infarction (NSTEMI) can frequently present atypical symptoms and non-diagnostic electrocardiogram. The detection of modest cardiac troponin T (cTnT) elevation is challenging for physicians needing to routinely triage these patients. Unfortunately, non-coronary diseases, such as acute heart failure (CHF), may cause cTnT elevation. Circulating microRNAs (miRs) have emerged as biomarkers of MI. However, their diagnostic potential needs to be determined in elderly NSTEMI patients.
92 NSTEMI patients (82.6 ± 6.9 years old; complicated by CHF in 74% of cases) and 81 patients with acute CHF without AMI (81.3 ± 6.8 years old) were enrolled at presentation. A third group comprised 99 age-matched healthy control subjects (CTR). Plasma levels of miR-1, -21, -133a, -208a, -423-5p and -499-5p were analyzed.
MiR-1, -21 -133a and -423-5p showed a 3- to 10-fold increase and miR-499-5p exhibited >80-fold increase in acute NSTEMI patient vs. CTR. MiR-499-5p and -21 showed a significantly increased expression in NSTEMI vs. CHF. Interestingly, mir-499-5p was comparable to cTnT in discriminating NSTEMI vs. CTR and CHF patients. Its diagnostic accuracy was higher than conventional and hs-cTnT in differentiating NSTEMI (n=31) vs. acute CHF (n=32) patients with modest cTnT elevation at presentation (miR-499-5p AUC=0.86 vs. cTnT AUC=0.68 and vs. hs-cTnT AUC=0.70).
Circulating miR-499-5p is a sensitive biomarker of acute NSTEMI in the elderly, exhibiting a diagnostic accuracy superior to that of cTnT in patients with modest elevation at presentation.
患有急性非 ST 段抬高型心肌梗死（NSTEMI）的老年患者常表现出非典型症状和非诊断性心电图。对于需要常规分诊这些患者的医生来说，检测适度的心肌肌钙蛋白 T（cTnT）升高具有挑战性。不幸的是，非冠状动脉疾病，如急性心力衰竭（CHF），可能导致 cTnT 升高。循环 microRNAs（miRs）已成为 MI 的生物标志物。然而，它们在老年 NSTEMI 患者中的诊断潜力仍需确定。
纳入 92 名 NSTEMI 患者（82.6±6.9 岁；74%的病例并发 CHF）和 81 名急性 CHF 无 AMI 患者（81.3±6.8 岁）。第三组包括 99 名年龄匹配的健康对照（CTR）。分析血浆中 miR-1、-21、-133a、-208a、-423-5p 和 -499-5p 的水平。
与 CTR 相比，miR-1、-21、-133a 和 -423-5p 的表达水平升高了 3-10 倍，miR-499-5p 的表达水平升高了 80 多倍。与 CHF 相比，miR-499-5p 和 -21 在 NSTEMI 中的表达明显升高。有趣的是，miR-499-5p 在区分 NSTEMI 与 CTR 和 CHF 患者方面与 cTnT 相当。与常规 cTnT 和 hs-cTnT 相比，miR-499-5p 在区分有适度 cTnT 升高的 NSTEMI（n=31）与急性 CHF（n=32）患者方面具有更高的诊断准确性（miR-499-5p AUC=0.86 比 cTnT AUC=0.68 和 hs-cTnT AUC=0.70）。
循环 miR-499-5p 是老年急性 NSTEMI 的敏感生物标志物，其诊断准确性优于有适度升高的 presentation 患者的 cTnT。
