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Title: An investigation into the potential utility of Intermedin (adrenomedullin-2) as a biomarker of myocardial ischaemia or infarction
Author: Morrice, K. W.
ISNI:       0000 0004 2745 1952
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2013
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Introduction: Elevated blood levels of Cardiac Troponin (cTnT) are the gold standard for diagnosis of acute coronary syndrome (ACS). However cTnT is not detectable for 3-4 hours after symptom onset; an early marker of myocardial ischaemia is therefore desirable. The peptide Calcitonin Gene-Related Peptide (CGRP) is released from nerve endings during myocardial ischaemia and has cardioprotective effects. Intermedin (IMD), from the same family, is elevated in myocardial infarction and oxidative stress in animal studies. Methods: I enrolled 81 patients with chest pain, suspected to have acute coronary syndrome to a chest pain study (1). Samples were taken on admission, at 12hours after pain, the next day and the following day. Samples were analysed for intermedin, & CGRP (radioimmunoassay) and High-Sensitivity troponin (HsTnT). Study 2 assessed 30 patients undergoing Percutaneous Coronary intervention (PCI) with 6 controls. Samples taken, pre, 1,5, 10,30, 120 or 240 minutes post balloon inflation and next day. Results: Study 1- Intermedin showed a non-significant trend towards elevation in ACS patients. In those patients who were (cTnT) negative «0.03ng/ml) on presentation, IMD & CGRP were significantly elevated. CGRP was significantly elevated at 12 hours after ACS onset and appeared to remain elevated for 48 hours. HsTnT identified more ACS on an admission sample than cTnT. Study 2 - IMD showed a small but significant rise at ten minutes after balloon inflation. HsTnT was significantly elevated the next day following PC!. Neither marker was related to number of stents/inflations, balloon pressure or length of inflation. Conclusions: The novel peptide IMD is elevated in ischaemia and infarction, but the rise is too small to be clinically useful. CGRP had a significant rise in ACS patients, but again of a small magnitude. The time course of their elevation is incompletely defined. HsTnT is more sensitive in ACS than cTnT on a presenting blood sample.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available