Whole blood choline and plasma choline in acute coronary syndromes: Prognostic and pathophysiological implications

Choline in Whole Blood and Plasma: Sample Preparation and Stability

“…Choline has been investigated as a biomarker for various pathological conditions. Increased choline concentrations in plasma and whole blood are important and independent predictors of major cardiac events (3)(4)(5)(6). Choline is a polar, nonvolatile molecule that lacks a chromophore and cannot be measured by immunoassay because of its small size and presence in all mammalian species.…”

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

“…NST-ACS 11.0 (9.0-11.8) UA 9.7 (7.9-12.0) NSTEMI [53]. The reasons for these discrepancies in study results may be attributed to differences in patient populations.…”

“…Such patients have a high likelihood of elevated choline levels due to severe global ischemia and also high rates of subsequent MACE such as cardiac death and left ventricular (LV)-failure. In fact, end points related to severe ischemia, such as subsequent LV-failure, appeared only in 1.1% (four patients) in the study by Body et al [8] and in 13% in the PCho study by Danne et al [53]. This interpretation is consistent with the finding that the PCho levels in the study by Danne et al were differently distributed with much higher values (9% of patients with PCho ≥ 25 µmol/l) compared with the study by Body et al with an interquartile range of 8.2-9.7 (male) and 7.1-11.4 (female).…”

“…Therefore, PCho was neither diagnostic for MI nor for UA in the study by Body et al (AUC: 0.48 for MI; AUC: 0.55 for UA). However, in severe forms of global tissue ischemia after cardiac arrest, hemodynamic instability, severe arrhythmias or LV-failure, this is not the case, and the choline washout from injured ischemic tissues is often sufficient to be distinguishable from basal choline levels, which explains why PCho was predictive for arrhythmias (hazard ratio: 8.1) and heart failure (hazard ratio: 6.0) in one study [53]. Studies are ongoing to evaluate whether choline may be helpful to predict the outcome in patients after resuscitated cardiac arrest.…”

“…The reasons for these discrepancies in study results may be attributed to differences in patient populations. The studies of Danne et al 2003 and2007 also included patients with other signs suggesting acute cardiac ischemia, including acute cardiopulmonary arrest probably due to acute myocardial ischemia [9,53]. Such patients have a high likelihood of elevated choline levels due to severe global ischemia and also high rates of subsequent MACE such as cardiac death and left ventricular (LV)-failure.…”