Changes in Cardiac Electrical Biomarker in Response to Coronary Arterial Occlusion: An Experimental Observation
Sudipta Chattopadhyay1,2, Felicia Adjei3, Attila Kardos3,4
1Department of Cardiology, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Kempston Road, Bedford, MK42 9DJ, UK. Sudipta.Chattopadhyay@nhs.net.
Insights
Cardiac electrical biomarker (CEB) increases during coronary occlusion, indicating ischemia. CEB during hyperemia accurately predicts fractional flow reserve, suggesting CEB can identify significant coronary artery disease.
Area of Science:
- Cardiology
- Biomarkers
- Ischemia Research
Background:
- Cardiac electrical biomarker (CEB) indicates myocyte polarity changes due to ischemia.
- CEB's utility in diagnosing acute coronary syndrome is proposed, but its response to coronary occlusion is unproven.
- Understanding CEB's behavior during and after coronary interventions is crucial for its clinical application.
Purpose of the Study:
- To investigate the effect of coronary occlusion on Cardiac Electrical Biomarker (CEB).
- To determine if CEB can predict fractional flow reserve (FFR) values indicative of ischemia.
- To assess the dynamic changes in CEB during and after percutaneous coronary intervention.
Main Methods:
- CEB was measured before, during maximal adenosine hyperemia (CEBhyp), during balloon inflations (CEBmax), and at 1, 2, and 3 hours post-percutaneous coronary intervention.
- Measurements were taken in 75 patients undergoing stenting (divided by FFR < 0.8 or ≥ 0.8) and 49 controls.
- Late recovery (LR) of CEB was defined as CEB at 3 hours post-PCI being greater than the median baseline CEB.
Main Results:
- Coronary occlusion significantly increased CEB, with CEBmax and early post-procedural values higher than baseline.
- CEBhyp was significantly higher in patients with FFR < 0.8 compared to those with FFR ≥ 0.8.
- CEBhyp accurately predicted an FFR < 0.8 (AUC 0.75, p=0.017), and CEBmax predicted late CEB recovery.
Conclusions:
- Coronary arterial occlusion increases CEB, which retains a 'memory' of the ischemic event.
- CEB measured during hyperemia (CEBhyp) is elevated specifically in ischemic conditions (FFR < 0.8).
- CEBhyp shows potential as a non-invasive method to identify significant coronary artery disease and guide intervention decisions.
Abstract:
Cardiac electrical biomarker (CEB), an indicator of ischaemia-induced change in myocyte polarity, has been proposed for diagnosis of acute coronary syndrome. However, effect of coronary occlusion on CEB has not been demonstrated. CEB was acquired before (CEB0), during maximal adenosine hyperaemia (CEBhyp), balloon inflations (CEBmax) and 1 (CEB1h), 2 (CEB2h) and 3 (CEB3h) h after percutaneous coronary intervention along with pre- and post-procedural troponin-I. CEB of subjects with non-cardiac chest pain without risk factors was used as controls (CEBc). "Late recovery" (LR) of CEB was defined as CEB3h > median-CEB0. CEB was recorded in 75 patients undergoing stenting (group 1) including 8 with FFR < 0.8 (group 1a), 25 with FFR ≥ 0.8 (group 2) and 49 controls. In group 1, CEB0 (median, IQR) was higher than CEBc (48.0; 29.5-88.3 vs 30.0; 17.0-44.0; p < 0.001). CEBmax (185; 105.0-331.0) was higher than CEB0 (p < 0.0001). CEB1h (78.0; 31.5-143.8; p < 0.0001) and CEB2h (63.0; 31.5-114.3; p = 0.039) were higher than CEB0 while CEB3h (54.0; 24.3-94.8, p = 0.152) was similar. LR occurred in 50.7% patients. CEBmax predicted LR (OR 1.01, 95% CI 1.00-1.01, p < 0.001) (AUC 0.759, p < 0.001). CEB0 in group 1a and group 2 were similar (p = 0.524). CEBhyp was higher than CEB0 in group 1a (126.0, 109.5-266.0 vs 47.5, 20.5-73.5; p = 0.016) and group 2 (44.0, 27.8-104.8 vs 39.0, 24.0-90.3; p = 0.014). CEBhyp was higher in group 1a than 2 (p = 0.039). CEBhyp (AUC 0.75, p = 0.017) accurately predicted FFR < 0.8. Coronary arterial occlusion increases CEB that retains a "memory" of the ischaemic event. CEBhyp was higher only when FFR was ischaemic and accurately identified FFR < 0.8.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Mechanism of Cardiac Arrhythmias
01:29Pathophysiology of Cardiac Performance
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials