Effects of balloon occlusion during percutaneous coronary intervention on circulating Ischemia Modified Albumin and transmyocardial lactate extraction

Abstract

S tudies have shown that human albumin undergoes a considerable reduction in its capacity to bind exogenous cobalt (Ischemia Modified Albumin (IMA); Ischemia Technologies, Denver, Colorado, USA), as measured by the albumin cobalt binding test, when exposed to an ischaemic insult. We have recently observed that plasma IMA levels increase soon after transient balloon inflation during percutaneous coronary intervention (PCI), even in the absence of considerable elevations of cardiac troponin. 1 Higher IMA levels have also been reported in patients with acute coronary syndrome attending the emergency department with recent-onset chest pain. 2 At present however, no data exist regarding the relationship between IMA and an accepted gold standard for myocardial ischaemia-that is, myocardial lactate extraction. 3 We therefore sought to assess whether increased IMA plasma levels documented in patients after PCI correlate with an increased production of lactate by the myocardium. METHODSWe simultaneously measured coronary sinus and arterial lactate concentrations and plasma IMA levels before and after balloon inflation in 10 patients with chronic stable angina undergoing PCI to the proximal left anterior descending coronary artery. The study protocol was approved by the local ethics committee, and informed written consent was obtained from all patients before study entry. Patients with signs or symptoms of acute or chronic ischaemic conditions, including stroke, transient ischaemic attack, leg claudication or shock, were not included. Blood was drawn for detecting IMA and lactate: (1) immediately before PCI, using arterial and venous sheaths; (2) 1 min after the last balloon inflation (arterial and coronary sinus measurements); (3) 5 min after PCI (arterial and coronary sinus measurements); (4) 1 h after PCI (peripheral vein) for IMA; and (5) 6 h after PCI (peripheral vein) for IMA. For coronary sinus lactate sampling, a multi-purpose catheter was inserted via right femoral vein puncture and positioned in the coronary sinus just proximal to the great cardiac vein. The position was checked repeatedly by injections of small amounts of contrast medium. IMA was measured using the albumin cobalt binding test on the Roche Cobas MIRA PLUS instrument (Rotkreuz, Switzerland). 1 2 In our laboratory, the albumin cobalt binding test within-run duplicate percentage of coefficient of variation (CV%) of patient samples ranged from 0% to 6.5%, with an average of 1.9%. Lactate concentration was measured by an enzymatic kit (Boehringer Mannheim, Mannheim, Germany) with intraassay and interassay CVs of 3.7% and 4.8%, respectively. The analytical range for the study was 0.3-11.1 mmol/l. Net lactate extraction was calculated using the formula: (arterial lactate2sinus lactate)/arterial lactate 6100%, with the normal range being 10-60% and ischaemia developing with lactate extraction of (10%. 4 Non-parametric descriptive and comparative statistics for continuous variables were determined using Analyse-it v.1.62 (Analyse-it Software, Leeds, UK). ...

Low basal levels of circulating adiponectin in patients undergoing coronary stenting predict in-stent restenosis, independently of basal levels of inflammatory markers: Lipoprotein associated phospholipase A2, and myeloperoxidase

“…It was shown that PCI represents a clinical model of myocardial reperfusion characterized by a postoperatory increase in oxidative stress [18]. APO may protect against ischemia-reperfusion myocardial injury by reducing ROS/reactive nitrogen species overproduction by multiple upstream signaling pathways [19], hence the possible intervention of APO in artery protection against ISR lesion.…”

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

“…ACB assay has been used in previous studies [35][36][37]. Lee et al [38] developed a cobalt albumin binding assay to correct the flaws of the ACB test with improving the sensitivity and precision.…”

A New Marker for Ischemia: Ischemia-modified Albumin

“…İskemik dokunun yeniden oksijenlenmesi ile reperfüzyonun ilk 1-5 dakikasında laktat ve ROS oluşumunu izleyen lipid ve protein peroksidasyon ürünleri dolaşıma salınmaktadır. PCI balon şişme sonrası kardiyak troponinler artmamasına rağmen plazma İMA seviyesi artmış olarak tespit edildi (28) . Bar-Or ve arkadaşları yaptığı çalışmada PCI sırasında uyarılan geçici iskemi sonrası ilk 24 saat içinde İMA anlamlı derecede yüksekti ve 6. saatte düşmeye başladığı gösterildi (29) .…”