Elevated renalase levels in patients with acute coronary microvascular dysfunction - A possible biomarker for
Basmah Safdar1, Xiaojia Guo2, Caitlin Johnson1
1Department of Emergency Medicine, New Haven, CT, United States of America.
Insights
Elevated levels of renalase, an anti-inflammatory protein, were found in patients with coronary microvascular dysfunction (CMD). Renalase may serve as a biomarker for ischemia in acute chest pain, warranting further investigation.
Area of Science:
- Cardiology
- Biomarker Discovery
- Inflammation Research
Background:
- Coronary microvascular dysfunction (CMD) is a cause of acute chest pain.
- Renalase is an anti-inflammatory protein with potential roles in cardiovascular health.
- The relationship between renalase, inflammation, and CMD requires further elucidation.
Purpose of the Study:
- To investigate the association between renalase, inflammatory markers, and CMD in patients presenting with acute chest pain.
- To determine if renalase can serve as a diagnostic biomarker for CMD.
Main Methods:
- Cardiac Rb-82 PET/CT imaging was used to diagnose coronary artery disease (CAD) and CMD.
- Blood samples were analyzed for renalase and various inflammatory markers.
- 80 patients with chest pain were categorized into normal, CAD, and CMD groups.
Main Results:
- Patients with CMD exhibited significantly higher median renalase levels compared to normal or CAD groups.
- Renalase levels were not significantly different between normal and CAD groups.
- Inflammatory marker levels were similar across all patient groups.
- Renalase independently predicted CMD and improved diagnostic models when combined with traditional risk factors.
Conclusions:
- Acute CMD is associated with elevated renalase levels, suggesting a role in ischemia.
- Renalase shows potential as a novel biomarker for diagnosing CMD in patients with acute chest pain.
- Larger clinical trials are needed to validate the diagnostic utility of renalase in CMD.
Aims:
We explored the relationship between inflammation, renalase an anti-inflammatory protein, and acute chest pain with coronary microvascular dysfunction (CMD).
Methods And Results:
We used cardiac Rb-82 PET/CT imaging to diagnose coronary artery disease (CAD/CALC) (defect or coronary calcification) and CMD (depressed coronary flow reserve without CAD) in patients with chest pain in an emergency department (ED). Blood samples were collected pre-imaging within 24 h of ED presentation and were analyzed for renalase and inflammatory markers including C-reactive protein, interleukins, interferon gamma, tumor necrosis factor, vascular endothelial growth factor, and metalloproteinases. Exclusions were age ≤30 years, myocardial infarction, hemodynamic instability, hypertensive crisis, heart failure or dialysis. Between 6/2014 and 11/2015, 80 patients undergoing PET/CT provided blood and were categorized as normal (18%), CAD/CALC (27%) and CMD (55%). Median renalase values were highest in patients with CMD (5503 ng/ml; IQR 3070) compared to patients with normal flows (4266 ng/ml; IQR 1503; p = 0.02) or CAD/CALC (4069 ng/ml IQR 1850; p = 0.004). CMD patients had similar median values for inflammatory markers as normal patients (p > 0.05). Renalase remained an independent predictor of CMD (OR 1.34; 95% CI = 1.1-1.7, per 1000 ng/ml) after adjustment for smoking, family history, obesity and Framingham risk score. In a model for CMD diagnosis with Framingham risk score, typical angina history and CRP, renalase improved discrimination from C-statistic = 0.60 (95% CI 0.47, 0.73) to 0.70 (95% CI, 0.59-0.82).
Conclusion:
We found elevated renalase in response to ischemia from acute CMD. Its role as a biomarker needs validation in larger trials.
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