Relationship between IMA in Different Age Groups and Gender Variance

Relationship between IMA in Different Age Groups and Gender Variance

Abstract

The purpose of the study was to find the relationship between IMA in different age groups and gender variance.IMA has been found to be present in high levels in cardiac ischemic patients. Many studies have been done on the relationship of other biomarkers such as troponin to gender and different age groups (Rodriguez-Ospina, 331; Wiviott et al, 1415).Therefore, further research need to be done to find out whether there exist differences in the levels of IMA between different age groups, and also in gender. The results of the study will be helpful in correct diagnosis of cardiac ischemia among patients, in addition to stratification of the patients that suffer from acute chest pains. Correct diagnosis means immediate treatment and management of the cardiac ischemia before it destroys the myocytes.

Introduction

Cardiac bio makers According to Rodriguez-Ospina et al (14) are substances released by the heart into the blood stream when it is stressed or damaged. Measurement of the released bio makers in the blood stream is helpful in diagnosis, monitoring, risk stratification and in management of people suspected to have cardiac ischemia and acute coronary syndrome (ACS). Cardiac ischemia results when blood supply that goes to the tissues of the heart is not enough to meet the needs of the heart. ACS results from plaque rapture that causes blood clot formation in the coronary arteries. This results in a sudden blood decrease and oxygen that reaches the heart. Rodriguez-Ospina et al (15) highlighted some of the different types of cardiac biomarkers tests but the most used and effective one is the troponin test. However, cardiac troponin is only specific and sensitive for detection of damage in myocardium, but sometimes may not rise in there is reversible myocardial ischemia. In contrast, recent studies have indicated that Ischemia Modified Albumin (IMA) is very sensitive and effective biochemical marker of ischemia (Wiviott et al, 1414; Sinha et al, 209|).  During ischemic attack, IMA is produced and is present in blood in concentrations that is easily detectable. Recent studies have also indicated that there exist differences in the levels of biomarkers in gender but minimal differences in different age groups (Sinha et al, 72; radha et al, 225). Wiviott et al (1413) indicated that diagnosis of diseases of the coronary artery in women is more difficult. This is because of lower diagnostic accuracy of the non invasive tests and lower symptoms specificity. In their study, they found out that in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA), there existed different patterns of biomarkers presentation. For instance, men had had a higher likelihood of elevated troponins and creatine kinase-MB. Women, on the other hand, had a higher likelihood of having elevated brain natriureitic peptide and C-reactive protein. Similarly, age differences exist in the level of bio makers. The levels of Brain Natriuretic peptide (BNP) are higher in older populations and women compared to men (Wiviott et al, 1413). Further research is needed to clarify whether pathophysiological differences that are gender related exist in acute coronary syndromes presentation. The aim of the study was to find out the levels of IMA in different age groups and gender variance

Methods

Ninety six patients with acute chest pain between age group 30-60years admitted in ICCU of hospital participated in the study. Among these subjects, 40 were male and 56 were female.  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. About 41% of the patients of group I was between 50-60 years of age. The control group of healthy subjects was 28, 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.

Of the 80 ischemic patients (group I) 34 were males and 46 females. The mean±SD age for the males was 50± 6.8 years and the female was 58±10.1 years. The control group was made up of 10 males and 18 females, and the mean±SD age was 45±8.6 years and 56±10.6 years respectively.

The patients of ischemic group (group 1) were further divided in to three groups based on their age &sex as follows; 30-40 years (M&F), 40-50 years (M&F), and 50-60 years (M&F).

Results

The mean±SD of CK-MB for the age group 30-40 years was normal in both males and females. But for the females of age group 40-50years it was higher (24±1.6) compared to males. Likewise, in the age group of 50-60 years in females the CKMB values (56±4.8) had high mean than males (52±6.0) .In addition  to CK-MB, the LDH values were also higher in females (225±6.4)  than males (198±10.6) .The LDH levels were  normal in other  two  groups. 

Discussion

Many important findings regarding IMA in different age groups and gender variance in Ischemic patients presenting with Co (II)-albumin binding assay for IMA have emerged from the analysis. Women had a higher likelihood of having IMA biomarker compared to men who were ischemic. Further analysis indicated that, as age increases (from 40 to 60 years) IMA levels get elevated among the ischemic patients. The study also shows correlation to a study done by Bar-Or D, Lau E, Winkler JV where myocardial ischemic patients had elevated assay levels, and for the age group of 50 to 60 years which had higher levels of IMA (Bar-Or et al, 12).

High levels of the IMA in women and the elderly is an indication that the accuracy of diagnosis of coronary heart diseases such as cardiac ischemia has been increased. The application of IMA to detect ischemia before destruction of the myocardium muscles will be helpful in treating the elderly who mostly suffer from the cardiac diseases such as cardiac ischemia. Furthermore, it would be helpful in stratification of the patients who have cardiac ischemic and normal chest pains (radha et al, 225).

Conclusion

In conclusion, despite the gender and age differences, IMA were higher in women, and gets elevated as age increases in ischemic patients. This is a breakthrough for the elderly and the women who are ailing from cardiac ischemia or just experience chest pain. Correct diagnosis would enable them get people treatment on time. 

Work Cited

Rodriguez-Ospina, LF, CP Rosales-Alvarez, and A Lopez-Mas. “Cardiac Biomakers for the Evaluation of Acute Coronary Syndrome.” Boletín De La Asociación Médica De Puerto Rico. 101.4 (2009). Print.

Sinha, M, Roy, D, Gaze, D, Collinson, P, & Kaski, J. “Role of “ischemia Modified Albumin”, a New Biochemical Marker of Myocardial Ischaemia, in the Early Diagnosis of Acute Coronary Syndromes.” BMJ Group, 2004. Print

[email protected], Govender, Radha, De Greef, Jacques, Delport, Rhena, Becker, Piet J., & Vermaak, William J.H.”Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects. Clinics Cardiv, 2008.” Internet resource.

Wiviott, Stephen D, Christopher P. Cannon, David A. Morrow, Kausik K. Ray, Marc A. Pfeffer, and Eugene Braunwald. ” Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction.” Journal of the American College of Cardiology. 46.8 (2005): 1411-1416. Print.

Bar-Or, D, E Lau, and JV Winkler. “A Novel Assay for Cobalt-Albumin Binding and Its Potential As a Marker for Myocardial Ischemia-a Preliminary Report.” The Journal of Emergency Medicine. 19.4 (2000): 311-5. Print.

Appendix:

Table No I: Age distribution in ischemic and control groups:

Ischemic subjects

(n=80)

Control group

(n=28)

Males(n=34)

Mean ± SD

Females(n=46)

Mean ± SD

Males(n=10)

Mean ± SD

Females(n=16)

Mean ± SD

50±6.8Years 58±10.1Years 45±8.6Years 56±10.6Years

 Table no II: Age wise distribution of cardiac markers in Ischemic group      

Table no III Mean ± SD of males & females in Ischemic & non isch

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Role of IMA in Diagnosis of Myocardial Ischemia in ischemic and non ischemic groups

Role of IMA in Diagnosis of Myocardial Ischemia in ischemic and non ischemic groups

Abstract

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.

Introduction

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. 

Methods

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).

Results

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: 

Discussion

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. 

Conclusion

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. 

Work Cited

Bar-Or, D, E Lau, and JV Winkler. “A Novel Assay for Cobalt-Albumin Binding and Its Potential As a Marker for Myocardial Ischemia-a Preliminary Report.” The Journal of Emergency Medicine. 19.4 (2012): 311-5. Print.

[email protected], Govender, Radha, De Greef, Jacques, Delport, Rhena, Becker, Piet J., & Vermaak, William J.H.”Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects. Clinics Cardiv, 2009.” Internet resource.

Rodriguez-Ospina, LF, CP Rosales-Alvarez, and A Lopez-Mas. “Cardiac Biomakers for the Evaluation of Acute Coronary Syndrome.” Boletín De La Asociación Médica De Puerto Rico. 101.4 (2009). Print.

Sinha, M, Roy, D, Gaze, D, Collinson, P, & Kaski, J. “Role of “ischemia Modified Albumin”, a New Biochemical Marker of Myocardial Ischaemia, in the Early Diagnosis of Acute Coronary Syndromes.” BMJ Group, 2014. Print

Wiviott, Stephen D, Christopher P. Cannon, David A. Morrow, Kausik K. Ray, Marc A. Pfeffer, and Eugene Braunwald. ” Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction.” Journal of the American College of Cardiology. 46.8 (2011): 1411-1416. Print.

Januzzi, James L. Cardiac Biomarkers in Clinical Practice. Sudbury, Mass: Jones and Bartlett Publishers, 2009. Print.

Tousoulis, Dimitris, and Christodoulos Stefanadis. Biomarkers in Cardiovascular Diseases. Boca Raton: CRC Press, 2013. Print.

Kazanis, K, M Dalamaga, C Nounopoulos, AS Manolis, N Sakellaris, G Jullien, and A Dionyssiou-Asteriou. “Ischemia Modified Albumin, High-Sensitivity C-Reactive Protein and Natriuretic Peptide in Patients with Coronary Atherosclerosis.” Clinica Chimica Acta; International Journal of Clinical Chemistry. 408 (2009): 1-2. Print.

Mowafy, H.H, M Hamdi, M Khaled, and M Ashraf. “The Role of Ima in Ruling Out Ischemia in Patients Presenting with Chest Pain, and Its Relation with the Extent of Coronary Artery Disease.” Egyptian Journal of Critical Care Medicine. 1.3 (2013): 145-149. Print.

Chawla, R, N Goyal, R Calton, and S Goyal. “Ischemia Modified Albumin: a Novel Marker for Acute Coronary Syndrome.” Indian Journal of Clinical Biochemistry : Ijcb. 21.1 (2010): 77-82. Print.

Yakut, Ibrahim, Cüneyt Tayman, Osman Oztekin, Mehmet Namuslu, Fahri Karaca, and Aydın Kosus. “Ischemia-modified Albumin May Be a Novel Marker for the Diagnosis and Follow-Up of Necrotizing Enterocolitis.” Journal of Clinical Laboratory Analysis. 28.3 (2014): 170-177. Print.

Gaze, DC. “Ischemia Modified Albumin: a Novel Biomarker for the Detection of Cardiac Ischemia.” Drug Metabolism and Pharmacokinetics. 24.4 (2009): 333-41. Print.

Aparci, M, E Kardesoglu, N Ozmen, O Ozcan, BS Cebeci, BY Cingozbay, and M Dincturk. “Prognostic Significance of Ischemia-Modified Albumin in Patients with Acute Coronary Syndrome.” Coronary Artery Disease. 18.5 (2011): 367-73. Print.

Charpentier, Sandrine, Jean L. Ducassé, Maxime Cournot, Françoise Maupas-Schwalm, Meyer Elbaz, Cécile Baixas, Henri Juchet, Thierry Lang, and Dominique Lauque. “Clinical Assessment of Ischemia-Modified Albumin and Heart Fatty Acid-Binding Protein in the Early Diagnosis of Non-St-Elevation Acute Coronary Syndrome in the Emergency Department.” Academic Emergency Medicine. 17.1 (2010): 27-35. Print. 

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