Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease.
The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5 +/- 19.1 compared with 8.2 +/- 9.6 kU/l respectively; P = 0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44-0.94); P = 0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25 +/- 0.71 years. An increase in IMA > or = 20 kU/l was associated with significantly worse survival (P = 0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA > or = 20 kU/l during DSE had significantly worse survival.
Sharma
Rajan
R
Department of Cardiology, St George's Hospital, Cranmer Terrace, London, UK. rajdoc.sharma@tiscali.co.uk
Gaze
David C
DC
Pellerin
Denis
D
Mehta
Rajnikant L
RL
Gregson
Helen
H
Streather
Christopher P
CP
Collinson
Paul O
PO
Brecker
Stephen J D
SJ
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism*
D015415:Biomarkers; D012709:Serum Albumin