The purpose of the study was to find out the Role of IMA in Diagnosis of Myocardial Ischemia in ischemic and non ischemic groups. Diagnosis of myocardial ischemia has been done using other bio markers such as troponin. However, their lower diagnostic accuracy, in addition to lower symptoms specificity has made them unreliable. IMA levels have been found to increase in cardiac ischemic patients, and this makes it useful in accurate diagnosis of cardiac ischemia. However, its role in the diagnosis of cardiac ischemia is little known. Therefore, the study aims to find out the role of IMA in the diagnosis. The results of the study indicated that ischemic patients had a higher level of IMA compared to the non ischemic patients. This will be useful when diagnosing a patient who has acute chest pain, and also stratifying the patients.
Ischemia Modified Albumin (IMA) according to Bar-Or et al (12) is a marker of myocardial ischemia. Ischemia modified albumin (IMA) from different studies have shown that it is an early marker in patients that are undergoing the process of coronary angioplasty for ischemia (Charpentier et al, 33). Moreover, IMA is very sensitive compared to cardiac troponin (cTn) and 12-lead ECG levels when diagnosing acute coronary syndrome (ACS) in patients that experience chest pain, and within three hours are attending the emergency department at the onset of the pain (Aparci et al, 369). Further research need to be done in chest pain patients to assess the role of IMA in myocardial ischemia as a marker.
The study was conducted on two groups; ischemic and non ischemic groups. 96 patients with acute chest pain between ages group30-60years were admitted in ICCU of hospital were included for the study. Among these subjects 40 were male and 56 were female. Out Of the 96 patients, 16 of them had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with evidence of myocardial ischemia were categorized into group I. Of the 80 ischemic patients (group I) 34 were males and 46 females. The control group had healthy subjects who were 28 in number, of which 10 were males and 18 females.
Patients were evaluated as being non ischemic or potentially ischemic through standard coronary disease indicators [(CK), CK-MB, LDH and electrocardiography findings] and were tested by a Co (II)-albumin binding assay for IMA. The patients of ischemic group are further divided in to three groups based on their age&sex as follows ; 30-40 yrs (M&F), 40-50 yrs (M&F), and 50-60 y0rs (M&F).
The mean±SD of CK-MB for the age group 30-40 yrs is normal in both males and females. But for the females of age group 40-50yrs it is higher (24±1.6) compared to males. Likewise, in the age group of 50-60 yrs in females the CKMB values (56±4.8) have high mean than males (52±6.0) .In addition to CK-MB the LDH values are also higher in females (225±6.4) than males (198±10.6) .The LDH levels are normal in other two groups.
Table: Cardiac bio marker in Ischemic and non ischemic groups:
From the results, the ischemic group had higher levels of IMA compared to the non ischemic group. This is an indication that patients with chest discomfort but have low IMA, in addition to other tests like the cTn, is enough rule out myocardial ischemia. This study reflects the previous study done by Januzzi (116) where the study found that the IMA was positive in four of five patients with evidence of ischemia in ECG being 16 of 20 patients who had negative ECG but with coronary ischemia. The combination of IMA along with the other standard biomarkers among these patients increases the sensitivity for detecting ischemia to 97% (Tousoulis et al, 102). Additionally, Sinha et al (112) conducted a study to find out the role of IMA in the early diagnosis of ACS among the ischemic patients. Diagnosing cardiac ischemia in patients that shows symptoms of ACS in emergency departments is often difficult. The study by Sinha et al (112) evaluated IMA with ECG and cTn among 208 patients at the emergency department with acute chest pain within three hours. The results of ECG, IMA and cTn, in combination and alone showed correlation with the final diagnosis of, ST segment elevation, unstable angina and non-ST segment elevation, non-ischemic chest pain myocardial infarction (Kazanis et al, 1). Gaze (335) indicated that in the entire group of patients under study, IMA sensitivity at presentation for the ischemic chest pain origin was 82% compared to ECG of 45%, and lastly cTnT of 20%. Similarly, when IMA was used in conjunction with cTn or ECG, the sensitivity was 92% and 90% respectively. However, when all the three tests were combined together identified 95% of chest pain patients attributed to ischemic heart disease (Charpentier et al, 31). This supports this study in which there is an appropriate setting in which to consider the use of the multimarker combination of IMA plus markers of myonecrosis would be for the rapid assessment of low to intermediate patients with chest discomfort risk. Correlation was also shown in a study conducted by Mowafy et al (145-149) which indicated that ischemic group had higher levels of IMA compared to the non ischemic group. Mowafy et al (145-149) conducted a study on the role of IMA in excluding ischemia from the coronary artery disease patients that had chest pains. The study was done on 50 patients with average age of 54.7 ± 9 years, and was grouped into three groups. Group one had 13 patients with unstable angina, group two had 17 patients with NSTEMI, and finally group three was the control group. The results indicated that IMA was significantly statistically higher in group one and two compared to group three patients (p value<0.05) (Mowafy et al, 145-149). The average level of IMA was significantly cardiac biomarkers that include TIMI risk score, troponin and a number of the vessels affected but not correlated to the short term prognosis and Modified Gensini Score (MGS). The optimal cutoff value of the levels of IMA in prediction of poor prognosis according to Yakut et al (174) was 9.65ng/ml. This study shows correlation to the findings of this study that showed that the ischemic group had higher levels of IMA compared to the non ischemic group. Therefore, it can be concluded that the IMA serum is a useful biomarker in ruling out patients who are non ischemic and are suspected to be suffering from ACS, and is related significantly to many affected blood vessels. The ability to detect ischemia using IMA before destruction of the myocyte will make it possible for more accurate and earlier management decisions for the patients suspected to be ailing from cardiac ischemia (Tousoulis et al, 752). Furthermore, it improves the ability to stratify patients with acute chest pain and in therapeutic decisions guidance.
In summary, IMA is an effective marker for ACS diagnosis. High negative predictive IMA values make it an independent predictor of ACS development among patients. Furthermore, IMA is not just specific to cardiac ischemia. This makes it potential as a biomarker for other acute ischemic events.
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