Department of Cardiology and Angiology, Medical Centre, Faculty of Medicine University Heart Centre Freiburg-Bad Krozingen, University of Freiburg Germany.
Clinic of Cardiology University Heart and Vascular Centre Hamburg, University Medical Center Hamburg-Eppendorf Hamburg Germany.
J Am Heart Assoc. 2024 Jul 16;13(14):e034194. doi: 10.1161/JAHA.124.034194. Epub 2024 Jul 11.
Biomarkers simplifying the diagnostic workup by discriminating between non-ST-segment-elevation myocardial infarction (NSTEMI) and infarct-like myocarditis are an unmet clinical need.
A total of 105 subjects were categorized into groups as follows: ST-segment-elevation myocardial infarction (n=36), NSTEMI (n=22), infarct-like myocarditis (n=19), cardiomyopathy-like myocarditis (n=18), and healthy control (n=10). All subjects underwent cardiac magnetic resonance imaging, and serum concentrations of matrix metalloproteinase-1 (MMP-1) and procollagen type I carboxy terminal propeptide (PICP) were measured. Biomarker concentrations in subjects presenting with acute coronary syndrome and non-ST-segment-elevation, for example NSTEMI or infarct-like myocarditis, categorized as the non-ST-segment-elevation acute coronary syndrome-like cohort, were of particular interest for this study. Compared with healthy controls, subjects with myocarditis had higher serum concentrations of MMP-1 and PICP, while no difference was observed in individuals with myocardial infarction. In the non-ST-segment-elevation acute coronary syndrome-like cohort, MMP-1 concentrations discriminated infarct-like myocarditis and NSTEMI with an area under the receiver operating characteristic curve (AUC) of 0.95 (95% CI, 0.89-1.00), whereas high-sensitivity cardiac troponin T performed inferiorly (AUC, 0.74 [95% CI, 0.58-0.90]; =0.012). Application of an optimal MMP-1 cutoff had 94.4% sensitivity (95% CI, 72.7%-99.9%) and 90.9% specificity (95% CI, 70.8%-98.9%) for the diagnosis of infarct-like myocarditis in this cohort. The AUC of PICP in this context was 0.82 (95% CI, 0.68-0.97). As assessed by likelihood ratio tests, incorporating MMP-1 or PICP with age and C-reactive protein into composite prediction models enhanced their diagnostic performance.
MMP-1 and PICP could potentially be useful biomarkers for differentiating between NSTEMI and infarct-like myocarditis in individuals with non-ST-segment-elevation acute coronary syndrome-like presentation, though further research is needed to validate their clinical applicability.
通过区分非 ST 段抬高型心肌梗死（NSTEMI）和类似梗死性心肌炎，具有简化诊断工作的生物标志物是一种未满足的临床需求。
总共 105 名受试者被分为以下组别：ST 段抬高型心肌梗死（n=36）、NSTEMI（n=22）、类似梗死性心肌炎（n=19）、心肌病样心肌炎（n=18）和健康对照组（n=10）。所有受试者均接受心脏磁共振成像检查，并测量基质金属蛋白酶-1（MMP-1）和前胶原 I 羧基末端前肽（PICP）的血清浓度。本研究特别关注在表现为急性冠状动脉综合征和非 ST 段抬高的受试者（例如 NSTEMI 或类似梗死性心肌炎）中，生物标志物浓度。与健康对照组相比，心肌炎患者的 MMP-1 和 PICP 血清浓度较高，而在心肌梗死患者中则没有差异。在非 ST 段抬高型急性冠状动脉综合征样队列中，MMP-1 浓度可以区分类似梗死性心肌炎和 NSTEMI，ROC 曲线下面积（AUC）为 0.95（95%CI，0.89-1.00），而高敏肌钙蛋白 T 则表现不佳（AUC，0.74 [95%CI，0.58-0.90]；=0.012）。在该队列中，应用最佳 MMP-1 截断值对类似梗死性心肌炎的诊断具有 94.4%的敏感性（95%CI，72.7%-99.9%）和 90.9%的特异性（95%CI，70.8%-98.9%）。在此背景下，PICP 的 AUC 为 0.82（95%CI，0.68-0.97）。通过似然比检验评估，将 MMP-1 或 PICP 与年龄和 C 反应蛋白结合到复合预测模型中可以提高其诊断性能。
MMP-1 和 PICP 可能是区分非 ST 段抬高型急性冠状动脉综合征样表现个体中 NSTEMI 和类似梗死性心肌炎的有用生物标志物，但需要进一步研究验证其临床适用性。
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