Abstract

The purpose of the study was to find the role of IMA in the diagnosis of myocardial ischemia in ischemic and nonischemic groups amongst different age groups and gender variance. Diagnosis of myocardial ischemia has been done using other biomarkers such as troponin. However, their lower diagnostic accuracy, in addition to lower symptoms specificity has made them unreliable. IMA is present in high levels in cardiac ischemic patients. Many studies have been done on the role of other biomarkers such as troponin to gender and different age groups of ischemic patients (Rodriguez-Ospina, 331; Wiviott et al, 1415). Therefore, further research needs to be done to find out whether there exist differences in the levels of IMA between different age groups, and also in gender in ischemic and nonischemic groups. The results of the study will be a helpful incorrect diagnosis of cardiac ischemia among patients, in addition to the 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.

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Introduction

Cardiac bio makers according to Rodriguez-Ospina et al (14) are substances released by the heart into the bloodstream when it is stressed or damaged. Measurement of the released bio makers in the bloodstream is helpful in diagnosis, monitoring, risk stratification, and management of people suspected to have cardiac ischemia and acute coronary syndrome (ACS). Cardiac ischemia results when the 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 creating awareness. The majority of the employees are not aware they are suffering from certain medical issues, such as high blood clot formation in the coronary arteries. This results in a sudden psychological effects. For example, 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 the myocardium but sometimes may not rise if there is reversible myocardial ischemia. In contrast, recent studies have indicated that Ischemia Modified Albumin (IMA) is a very sensitive and effective biochemical marker of ischemia (Wiviott et al, 1414; Sinha et al, 209|).  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. 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. During the 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 the lower diagnostic accuracy of the noninvasive 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 natriuretic 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 in America. (1990). Black 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. Similarly, further study can be done on real-life populations of the patients to assess the role of IMA in myocardial ischemia as a marker. The study aimed to find out the levels of IMA in ischemic and nonischemic groups amongst different age groups and gender variance.

Methods

Ninety-six patients with acute chest pain between the 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 had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with human society develop. The evidence of myocardial ischemia was 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 nonischemic 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 the ischemic group (group 1) were further divided into 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).

Methods

The study was conducted on two groups; ischemic and nonischemic groups. 96 patients with acute chest pain between age group 30-60 years admitted in ICCU of hospital participated in the study. Among these subjects, 40 were male and 56 were female.  Of the 96 patients, 16 had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with human society develop. The evidence of myocardial ischemia was categorized into group I. Of the 80 ischemic patients (group I) 34 were males and 46 females. 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 nonischemic 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 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 the ischemic group (group 1) were further divided into 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 the other two groups.

The mean ±SD of IMA in the ischemic group (Group I, n=80) was 0.519±0.086 ABSU which was much higher when compared to control subjects with no evidence of ischemia (Group2, n=16) 0.316±0.092ABSU. This is statistically significant with a P-value of <0.001. The Group 1 patients had high levels than a decision threshold of 0.400 ABSU (ABSU>/=0.400).

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. The ischemic group had higher levels of IMA compared to the nonischemic group. Similarly, skeletal muscles. In a study conducted by (), the findings indicated that HRT improves the functions of muscles in Women had a higher likelihood of having IMA biomarker compared to ischemic men, this is in correlation to a study done by Kazanis et al (). Further analysis indicated that as age increases (from 40 to 60 years) IMA levels get elevated among the ischemic patients. The study also shows a correlation to a study done by Bar-Or et al (12) where myocardial ischemic patients had elevated assay levels ((0.529±0.086)), and for the age group of 50 to 60 years which had higher levels of IMA. The clinical diagnosis was assigned and correlated with standard biomarker (CK, CK-MB, and LDH) test results which were high compared with group II (0.316±0.092) with no human society develops. The evidence of myocardial ischemia (Bar-Or et al, 12).

In a previous study done by Januzzi (116), IMA was positive in four of five patients with pipeline of school to prison. Ecenbarger (2012) believes that that evidence of ischemia in ECG being 16 of 20 patients who had negative ECG but with coronary ischemia (Rodriguez-Ospina et al, 228). 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). 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.

High levels of the IMA in Women in America. (1990). The Black women and the elderly are an indication that the accuracy of the diagnosis of coronary heart diseases such as cardiac ischemia has been increased (Sinha et al, 89). The application of IMA to detect ischemia before the destruction of the myocardium muscles will help treat the elderly who mostly suffer from cardiac diseases such as cardiac ischemia. Furthermore, it would be helpful in the stratification of the patients who have cardiac ischemic and normal chest pains (Radha et al, 225).

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 only. This makes it potential as a biomarker for other acute ischemic events. Similarly, the increase in the level of IMA in women, and as age increases in ischemic patients 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 to get people treatment on time.

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 (2000): 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 Cardiff, 2008.” 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, 2004. 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 (2005): 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.

Table No I: Cardiac biomarker in Ischemic and nonischemic groups: 

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

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

Table no IV Mean ± SD of males & females in Ischemic & nonischemic group          

Herman Bailey

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