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New test helps identify impending heart attack

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Chest pain can be due to a medical problem ranging from indigestion to a heart attack. When chest pain occurs, the patient often presents at an emergency department for care. Often, today’s emergency departments are overburdened with a sea of patients with conditions ranging from minor to severe. A new test, developed by researchers at the Scripps Research Institute in La Jolla, California can help identify patients who are at very high risk of a heart attack by finding a specific biomarker in the bloodstream. The test was described on January 9 in the journal Physical Biology.

According to the Los Angeles Department of Public Health, coronary heart disease is the leading cause of mortality worldwide. This condition is due to the formation of atherosclerotic plaques, which frequently ulcerate or rupture. These events can result in the formation of a blood clot that can disrupt blood flow to the heart; thus, causing a myocardial infarction (MI; heart attack). The study authors note that prior to the MI, the inflammation within the arterial wall results in a shedding of cells lining the blood vessels in the heart; thus, leading to an increased number of circulating endothelial cells (CECs) in the blood. They note that CECs have been found to be an indicator of arterial plaque disruption. The increased numbers of CECs has been strongly associated with an ongoing MI; thus, measurement of CECs could aid in the diagnosis of an MI. The researchers explain that, at present, there is no method to reliably predict a heart attack because all of the tests for coronary artery disease (e.g., coronary angiography) are conducted to detect the underlying high risk conditions such as decreased blood flow to the heart rather than the likelihood of a significant plaque rupture. They stress that the ability to identify individuals at the greatest risk of heart attack before it becomes clinically evident is considered to be the most important unmet need in cardiovascular medicine.

The researchers noted that after analysis of more than 10 million cells, they were able to develop a computational procedure that could detect the CECs by their features and interactions with specific antibodies. They then used their procedure, called the High-Definition Circulating Endothelial Cell (HD-CEC) assay, on 79 patients who had just experienced a heart attack; they compared the findings to those of 25 healthy patients. The test, which involves drawing a small blood sample, revealed that the heart attack patients had significantly elevated levels of CECs compared to the healthy control group.

Because of the technique’s success, the researchers plan to utilize the procedure on patients with symptoms of a heart attack in order to forecast which ones will have a heart attack within the coming days or weeks. They are hopeful the test will be very predictive, because it correctly separated the heart attack patients from the healthy patients 100%. The knowledge that an MI is imminent can result in intervention methods that can reduce the risk of a MI and resultant damage to the heart muscle.

Take home message:

This test appears to hold promise for the prompt diagnosis of an impending heart attack; thus, it may be extremely helpful in separating patients with a serious condition from ones with a minor problem. With the implementation of Obamacare, healthcare analysts predict an influx of patients presenting at hospital emergency departments, many of which are currently very busy.