Unveiling differences between patients with acute coronary syndrome with and without ST elevation through
Shama Naz1, Ángela Algaba Calderón2, Antonia García1
1CEMBIO, Facultad de Farmacia, Universidad CEU San Pablo, Madrid, Spain.
Insights
New metabolomic biomarkers, including carnitine and amino acid ratios, show promise for diagnosing difficult Acute Coronary Syndrome cases. These findings could improve patient classification and treatment strategies.
Area of Science:
- Cardiology
- Metabolomics
- Biomarker Discovery
Background:
- Acute Coronary Syndrome (ACS) diagnosis relies on electrocardiograms and biomarkers, but some cases remain inconclusive.
- There is a clinical need for additional biomarkers to accurately classify patients with challenging ACS presentations.
Purpose of the Study:
- To identify novel metabolic biomarkers for improved diagnosis of Acute Coronary Syndrome.
- To explore the utility of metabolomics for discovering differentiating metabolites in ACS patients.
Main Methods:
- Serum samples from ST-elevation and non-ST-elevation myocardial infarction patients were analyzed using capillary electrophoresis-mass spectrometry (CE-MS) for metabolic fingerprinting.
- Targeted hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-MS-QqQ) was employed to quantify specific metabolites, including carnitine-related compounds and amino acids.
- Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of identified metabolite ratios.
Main Results:
- Metabolomic analysis revealed significant differences in carnitine-related compounds and amino acids between ACS patient groups.
- Specific ratios, such as free carnitine to acylcarnitines and acetylcarnitine to betaine/threonine/citrulline, demonstrated high diagnostic significance and accuracy (high area under the curve).
Conclusions:
- Carnitine and amino acid metabolite ratios represent promising novel biomarkers for refining the diagnosis of Acute Coronary Syndrome.
- These findings offer new avenues for developing improved diagnostic strategies for patients with difficult-to-classify ACS.
Abstract:
Differences in the degree and severity of Acute Coronary Syndrome, associated to differences in the electrocardiogram, together with blood tests of biomarkers classify patients for diagnosis and treatment. Cases where the electrocardiogram and/or biomarkers are not conclusive still appear, and there is a need for complementary biomarkers for routine determinations. Metabolomics approaches with blind fingerprinting could reveal differences in metabolites, which must be confirmed by means of targeted determinations. CE-MS and HILIC-MS are well suited for the determination of highly polar compounds, like those from to the intermediate metabolism, altered due to acute stress induced by myocardial infarction. Serum from patients with ST-elevated and non-ST elevated myocardial infarction was collected at intensive care and emergency units, and fingerprinted with CE-MS. Data pretreatment and analysis showed up carnitine-related compounds and amino acids differentially present in both groups. Acylcarnitines and amino acids were then quantitatively measured with HILIC-MS-QqQ. The significance of the differences and the sensitivity/specificity of each compound were individually evaluated. The ratio of free carnitine to acylcarnitines, together with the ratios of acetylcarnitine to betaine, to threonine, and to citrulline, showed high significance and area under the curve in the respective receiver operating characteristic curves. This study opens new possibilities for defining new sets of biomarkers for refining the diagnosis of the patients with difficult classification.
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