title: Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease.
abstract: 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.
authors.affiliation: Department of Cardiology, St George's Hospital, Cranmer Terrace, London, UK. rajdoc.sharma@tiscali.co.uk
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: David C
authors.initials: DC
authors.lastname: Gaze
authors.forename: Denis
authors.initials: D
authors.lastname: Pellerin
authors.forename: Rajnikant L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Helen
authors.initials: H
authors.lastname: Gregson
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Streather
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: Stephen J D
authors.initials: SJ
authors.lastname: Brecker
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin