The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5±19.1 compared with 8.2±9.6 kU/l respectively; P=0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44–0.94); P=0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25±0.71 years. An increase in IMA ≥20 kU/l was associated with significantly worse survival (P=0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA ≥20 kU/l during DSE had significantly worse survival.
Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease
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Rajan Sharma, David C. Gaze, Denis Pellerin, Rajnikant L. Mehta, Helen Gregson, Christopher P. Streather, Paul O. Collinson, Stephen J. D. Brecker; Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease. Clin Sci (Lond) 1 July 2007; 113 (1): 25–32. doi: https://doi.org/10.1042/CS20070015
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