Serological evidence of early remodeling in high-risk non-ST elevation acute coronary syndromes

Time course of early changes in plasma markers of collagen turnover following percutaneous transluminal coronary angioplasty

INTRODUCTION

Marked changes occur in the collagen framework of the heart following acute ischemia, which is associated with adverse ventricular remodelling. Plasma markers of collagen turnover are useful in the assessment of remodelling and have predictive value, but their exact temporal dynamics following ischemia are unclear.

OBJECTIVE

To characterize the early temporal dynamics of plasma markers of collagen turnover in a human model of coronary artery occlusion.

METHODS

Fourteen patients undergoing elective percutaneous coronary intervention (PCI) to a single coronary artery were recruited in addition to a control group of eight patients undergoing elective diagnostic coronary arteriography. Sequential assessment of plasma levels of procollagen type I carboxyterminal propeptide and C-telopeptide for type I collagen (CITP) as markers of synthesis and degradation, respectively, was performed over a 16 h period.

RESULTS

The ischemic burden in the PCI group was high, with 13 of the 14 patients demonstrating transient ST segment shift or positive troponin. Mean plasma levels of CITP on admission were 3.1 ng⁄mL and 3.0 ng⁄mL in the PCI and control groups, respectively (P value nonsignificant). There was a sequential increase in plasma CITP following PCI, peaking at 4.7 ng⁄mL at 16 h (P<0.01), with no change in the control group. There were no significant changes in plasma levels of procollagen type I carboxyterminal propeptide in either group.

CONCLUSIONS

Plasma levels of CITP demonstrated early temporal dynamics of collagen degradation following transient coronary artery occlusion supporting the use of plasma markers of collagen turnover as an early tool in the assessment of the remodelling process following myocardial ischemia.

Relation of high concentrations of plasma carboxy-terminal telopeptide of collagen type I with outcome in acute myocardial infarction

Acute myocardial infarction (AMI) is associated with matrix metalloproteinase activation. The plasma concentrations of carboxy-terminal telopeptide of collagen type I (CITP) reflect collagen type I degradation due to matrix metalloproteinase activation. We assessed the role of CITP as an early marker of outcome in AMI. Plasma CITP was measured 72 hours after hospital admission in 432 patients presenting with AMI. The 2 composite end points of the study (death, resuscitated cardiac arrest, recurrent AMI or ischemia, and heart failure or stroke; and death, resuscitated cardiac arrest, or heart failure) and mortality were assessed at 1 year in 4 patient groups stratified by the CITP quartiles. Patients with ST-segment elevation MI represented 75.7% of the population. In-hospital percutaneous coronary intervention was performed in 70.4% of the patients. The mean left ventricular ejection fraction was 53.9 +/- 12.5%. At 1 year of follow-up, high levels of CITP were associated with the occurrence of both composite end points and mortality (p <0.01 for all). Stepwise logistic regression analysis identified CITP as an independent predictor of both composite end points (odds ratio 2.14, 95% confidence interval 1.34 to 3.42, p = 0.001; and odds ratio 3.19, 95% confidence interval 1.50 to 6.81, p = 0.003), along with the Killip class and brain natriuretic peptide levels. In conclusion, high hospital levels of CITP, a marker of collagen degradation and ventricular remodeling, are associated with late mortality and other serious clinical events after AMI.

Ultrasensitive flow-based immunoassays using single-molecule counting

BACKGROUND

Immunoassay (IA) technology has expanded the clinical utility of protein biomarkers, but demands for increased sensitivity, dynamic reporting ranges, and small sample volumes have limited the potential clinical usefulness of many biomarkers. We assessed the performance, including limits of detection (LODs) and the dynamic reporting range, of an IA-based technology, Erenna Immunoassay System, for a series of biomarkers, including cardiac troponin I (cTnI).

METHODS

Erenna IAs were used with 10 different and clinically important biomarkers to ascertain the LOD with various sample sizes (10 microL to 200 microL).

RESULTS

The Erenna Immunoassay System generated LODs of 10-100 pg/L using 100 microL of sample. For cTnI, the LOD was 0.2 ng/L and a 10% CV was seen between 0.78 and 1.6 ng/L.

CONCLUSIONS

The Erenna IA-based technology reproducibly measures protein biomarkers with detection limits of 10-100 pg/L, with a dynamic range of >4.5 logs in sample volumes of 50-150 microL.