A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome

Abstract

Aim:The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS).Materials and Methods:This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals.Results:Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96–111.70] vs. 41.11 [95% CI: 38.55–43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2–99.5), 61.3% (95% CI: 49.5–72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0–6 h were 0.932 (95% CI: 0.87–0.97, P < 0.001) and 0.797 (95% CI: 0.71–0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively.Conclusion:hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

Diagnostic and prognostic value of biomarkers in acute myocardial infarction

“…In patients with suspected ACS, the diagnostic accuracy at presentation increased when IMA was used in conjunction with cTnT and ECG findings 25. In fact, IMA in combination with initial cTnT is more sensitive than the latter alone for predicting adverse cardiac events, although the specificity and sensitivity for IMA are too low to be useful for clinical decision-making 26…”

Changes in ischemia-modified albumin in myocardial toxicity induced by anthracycline and docetaxel chemotherapy

“…Once these free radicals in local myocardium increased, an increase in IMA would be subsequently induced. [ 13 , 18 – 22 ]…”

“…IMA concentration rapidly increased in 5 to 10 minutes postmyocardial ischemia in peripheral blood, and sustained increase during the course of ischemia, it would lasted for 2 to 4 hours, and returned to baseline level in 6 to 10 hours. [ 11 , 12 ] Since it can be detected in the reversible phase of myocardial injury, and possesses the advantages of high sensitivity, high negative predictive value and early appearing, [ 13 ] it has become a hot topic in clinical research.…”

Post-Myocardial Infarction Ventricular Remodeling Biomarkers—The Key Link between Pathophysiology and Clinic

“…In acute ischemia, the N-terminal end of albumin is damaged, reducing its ability to bind. It has been used in several studies that have shown its usefulness in the diagnosis of acute coronary syndromes in conjunction with tropine values and ECG changes [ 52 ]. It has been shown that this combination of biomarkers (troponin and modified albumin) has a predictive value higher than any of them taken separately [ 53 ].…”