Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
BMC Cardiovasc Disord. 2024 Aug 22;24(1):436. doi: 10.1186/s12872-024-04108-2.
Acute coronary syndrome (ACS) is a type of coronary heart disease (CHD), which is responsible for one-third of total deaths in people older than 35 years. Even though cardiac troponin is the gold standard for myocardial necrosis it is blind for ischemia without necrosis. Studies demonstrate that Ischaemia Modified Albumin (IMA) is more sensitive in diagnosing ischemic chest pain compared to cardiac troponin T and electrocardiogram, and its combination with these tests significantly increases the sensitivity for diagnosing unstable angina, non-ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI), with high positive and negative predictive values, making it a valuable tool for ruling out ACS in patients with inconclusive diagnoses in the emergency department.
This prospective cohort study, conducted at the Teaching Hospital, Peradeniya, Sri Lanka, from 2015 to 2019, investigated ischemia-modified albumin (IMA) levels in 330 acute coronary syndrome (ACS) patients. Excluding those with various chronic conditions and those on specific medications, serum IMA was analyzed using a colorimetric assay based on cobalt (II) binding to human serum albumin affected by myocardial ischemia. Serum IMA levels were measured, and statistical analyses, including non-parametric tests and correlation analyses, were conducted to evaluate the association between IMA levels and various demographic and clinical factors.
IMA concentrations were found to be non-normally distributed, with an average concentration of 0.252 ± 0.123 AU. No overall significant gender-based difference in IMA levels was observed, though within the younger age group (< 59 years), males exhibited higher IMA concentrations than females. Significant gender differences were observed in the younger age group, with males showing higher IMA levels than females (p = 0.033). No significant differences in IMA levels were found across different ethnicities (p = 0.217) or BMI categories (p = 0.056). A significant increase in IMA levels was noted in ACS patients compared to control subjects (p < 0.001). Correlation analysis revealed significant associations between IMA levels and total cholesterol (r = 0.262, p = 0.009) and low-density lipoprotein (LDL) levels (r = 0.280, p = 0.006). Notably, a significant gender difference in IMA levels was found in obese patients, suggesting physiological differences in response to obesity. The study also revealed higher IMA concentrations in NSTEMI and STEMI patients compared to those with unstable angina.
The study confirms elevated IMA levels in ACS patients, supporting its diagnostic potential. It reveals demographic influences, such as higher IMA levels in younger males and significant gender-specific differences in obese patients. Personalized approaches considering demographics and lipid management are essential for ACS risk reduction and IMA's role in management.
急性冠状动脉综合征（ACS）是一种冠心病（CHD），占 35 岁以上人群总死亡人数的三分之一。虽然心肌肌钙蛋白是心肌坏死的金标准，但它对无坏死的缺血是盲目的。研究表明，与心肌肌钙蛋白 T 和心电图相比，缺血修饰白蛋白（IMA）在诊断缺血性胸痛方面更敏感，其与这些检测方法联合使用可显著提高不稳定型心绞痛、非 ST 段抬高型心肌梗死（NSTEMI）或 ST 段抬高型心肌梗死（STEMI）的诊断敏感性，具有较高的阳性和阴性预测值，是排除急诊科诊断不明确的 ACS 的有价值的工具。
本前瞻性队列研究于 2015 年至 2019 年在斯里兰卡佩拉德尼亚教学医院进行，共纳入 330 例急性冠状动脉综合征（ACS）患者。排除患有各种慢性疾病和使用特定药物的患者后，采用基于钴（II）与受心肌缺血影响的人血清白蛋白结合的比色法分析血清 IMA。测量血清 IMA 水平，并进行非参数检验和相关性分析等统计分析，以评估 IMA 水平与各种人口统计学和临床因素之间的关系。
发现 IMA 浓度呈非正态分布，平均浓度为 0.252±0.123 AU。虽然在年轻组（<59 岁）中，男性的 IMA 浓度高于女性，但总体上 IMA 水平无显著性别差异。在年轻组中观察到显著的性别差异，男性的 IMA 水平高于女性（p=0.033）。不同种族（p=0.217）或 BMI 类别（p=0.056）之间的 IMA 水平无显著差异。ACS 患者的 IMA 水平明显高于对照组（p<0.001）。相关性分析显示，IMA 水平与总胆固醇（r=0.262，p=0.009）和低密度脂蛋白（LDL）水平（r=0.280，p=0.006）显著相关。值得注意的是，在肥胖患者中发现 IMA 水平存在显著的性别差异，表明肥胖时存在生理反应的差异。该研究还显示，NSTEMI 和 STEMI 患者的 IMA 浓度高于不稳定型心绞痛患者。
该研究证实 ACS 患者的 IMA 水平升高，支持其诊断潜力。它揭示了人口统计学方面的影响，如年轻男性的 IMA 水平较高，肥胖患者的性别特异性差异显著。考虑人口统计学和脂质管理的个性化方法对于降低 ACS 风险和 IMA 在管理中的作用至关重要。
