Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

Abstract

Objective:Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels.Methods:This was a prospective, multicenter study that included 70 patients hospitalized with acute decompensated HF and left ventricular ejection fraction <35%. Blood samples for IMA measurements were obtained on admission and 24-48 h after the initiation of HF therapy. Twenty-nine patients were treated with standard HF therapy, 18 received levosimendan, and 23 received dobutamine in addition to standard of care. A single serum specimen was also collected from 32 healthy individuals each. IMA concentrations were measured by the albumin cobalt binding colorimetric assay, and the results were given in absorbance units (AU). Independent and paired sample t-tests, Mann-Whitney U test, and Wilcoxon signed-rank test were used for the analysis.Results:In patients with acute decompensated HF, the serum concentration of IMA was significantly higher than those of healthy subjects (0.894±0.23 AU vs. 0.379±0.08 AU, p<0.001). Overall, the IMA levels significantly decreased after 24-48 h of HF therapy (0.894±0.23 AU and 0.832±0.18 AU, p=0.013). Furthermore, the IMA levels were also found to significantly decrease with standard HF therapy (1.041±0.28 vs. 0.884±0.15 AU, p=0.041), with levosimendan (0.771±0.18 vs. 0.728±0.18 AU, p=0.046) and also with dobutamine (0.892±0.18 vs. 0.820±0.13 AU, p=0.035).Conclusion:Patients with acute decompensated HF had elevated IMA levels, and appropriate HF therapy significantly reduced the serum IMA levels. Dobutamine or levosimendan did not increase the IMA levels, suggesting a lower potential in inducing myocardial ischemia when used in recommended doses.

Role of ischemia-modified albumin in patients with acute decompensated heart failure

“…Previous data on serum concentrations of IMA in patients with HF are limited. Dominguez-Rodriguez et al ( 8 ) showed that IMA levels are related to the left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention and in those who developed acute HF IMA demonstrated a high sensitivity and negative predictive value for the diagnosis of HF In agreement with this previous study, Çavuşoğlu et al ( 7 ) showed that IMA is not only a promising biomarker for the diagnosis of acute HF but also useful for assessing the effect of inotropic therapy for acute HF.…”

“…In this issue, Çavuşoğlu et al ( 7 ) report the results of the first study to investigate IMA levels in patients with acute HF treated with dobutamine or levosimendan. They found that patients presenting with acute HF had elevated levels of IMA and also suggested that in-hospital acute HF therapy significantly reduced serum IMA levels.…”

“…The impact of serum albumin on IMA levels is an important factor, even within the normal range ( 13 ), and given that hypoalbu-minemia is common in patients with HF, the possible effects of hypoalbuminemia on IMA must be considered. Finally, although the study by Çavuşoğlu et al ( 7 ) study suggested that IMA is a highly sensitive biomarker with diagnostic potential for the assessment of acute HF, problems with the stability of IMA and its lack of cardiac specificity have been reported ( 14 , 15 ). The results of the current study suggest that the value of IMA lies in its ability to exclude, rather than confirm, the presence of acute HF, suggesting that its greatest value lies in patient reassurance.…”

Are Endocan and Ischemia-Modified Albumin Reliable Biomarkers for Endothelial Dysfunction in Type 2 Diabetes Mellitus?

“…[2][3][4] It has also been shown that serum endocan and IMA levels were significantly higher in infectious and other chronic diseases. [5][6][7] Balamir et al 1 did not mention whether acute or chronic infectious disease was an exclusion criterion in their study.…”