The evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end stage renal disease

Rajan Sharma (1) , David C Gaze (2) , Paul O Collinson (2) , Denis Pellerin (3) , Helen Gregson (2) , Christopher P Streather (2) , Stephen J Brecker (2)

1 Ealing Hospital
2 St Georges Hospital
3 The Heart Hospital [London]

Background. The early diagnosis of myocardial ischaemia is problematic in patients with end stage renal disease (ESRD). The study aim was to determine whether Ischemia Modified Albumin (IMA) rises during dobutamine stress and detects myocardial ischaemia in patients with ESRD. Methods. 114 renal transplant candidates were prospectively studied. All received dobutamine stress echocardiography (DSE). IMA levels were taken at baseline and 1 hour after cessation of DSE. Results: 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE positive and negative groups. The rise in IMA was significantly higher in the DSE positive group compared to those with no ischaemic response (26.5 ± 19.1 KU/L vs 8.2 ± 9.6 KU/L, p 0.007). From ROC analysis, the optimal IMA rise to predict an ischaemic response was 20 KU/L, with sensitivity 81% and specificity 72% (AUC = 0.80, 95%; CI 0.44, 0.94; p = 0.03). There were 18 deaths, 10 cardiac over a follow up period of 2.25 ± 0.71 years. An IMA rise > 20 KU/L was associated with significantly worse survival (p = 0.02). Conclusions: IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an IMA rise > 20 KU/L during DSE had significantly worse survival.

Mots clés: Medicine

Domaines: Médecine humaine et pathologie

Rajan Sharma, David C Gaze, Paul O Collinson, Denis Pellerin, Helen Gregson, et al.. The evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end stage renal disease. Clinical Science, 2007, 113 (1), pp.25-32. ⟨10.1042/CS20070015⟩. ⟨hal-00479362⟩