Background: This study explored the levels and prognostic value of ischemia modified albumin (IMA), red blood cell distribution width (RDW), and lipoprotein (LP) in patients with diabetes melltus (DM) complicated withcoronary heart disease (CHD).

Methods: A total of 95 patients with DM who were diagnosed and treatedfrom January 2018 to January 2019 were retrospectively analyzed. All included patients underwent percutaneous coronary intervention (PCI). Patients with DM complicated with CHDwere designated group A (n=61) and patients without CHD complications were designated group B (n=34). During the same period, 45 patients without DM who underwent physical examination in our hospital were included as a control group.The levels of IMA, LP, and RDW in the 3 groups of patients were compared. The study examined the occurrence of cardiovascular events after PCI treatment in patients with DM complicated with CHD, and the related risk factors were assessed using multivariate logistic regression analysis. Furthermore, the receiver operating characteristic (ROC) curve was used to analyze the value of IMA, LP, and RDW in predicting cardiovascular events in DM patients complicated with CHD.

Results: The levels of IMA, LP, and RDW werehigher in groups A and B compared to the control group (P<0.05). In patients who experienced a cardiovascular event, the levels of IMA, LP, and RDW were higher than those observed in patients who did not experience a cardiovascular event (P<0.05). The area under the ROC curve of IMA, LP, RDW, and the combination of the three factors for the prediction of cardiovascular events were 0.910, 0.774, 0.846, and 0.995, respectively. The combined detection of the 3 factors showed the best predictive value.Patients with abnormal values in blood lipids, blood creatinine, IMA, LP, and RDW had a significantly poorer prognosis in terms of adverse cardiovascular events (P<0.05). The unconditional multivariate logistic regression model showed that abnormal levels of blood creatinine, IMA, LP, and RDW were independent risk factors for cardiovascular events in patients with DM complicated with CHD after PCI treatment (P<0.05).

Conclusions: The levels of IMA, RDW, and LP wereincreased in patients with DM complicated with CHD. Furthermore, abnormal levels of IMA, LP, and RDW are independent risk factors that affect cardiovascular events in these patients following PCI treatment. The combined detection of all three indicators may be an effective means to predict the prognosis of these patients.

Keywords: Ischemia modified albumin (IMA); diabetes mellitus complicated with coronary heart disease (CHD); lipoprotein (LP); percutaneous coronary intervention treatment (PCI treatment); red blood cell distribution width (RDW).

Objectives: This study was aimed at assessing the ability of ischemia-modified albumin (IMA) to predict renal injury by associating biochemical, functional, and pathological findings with various degrees of ureteral obstruction.

Methods: Twenty-four rats were randomized into three groups, and their blood was sampled to determine the creatinine and IMA values and renal scintigraphy was done at the start and on postoperative day 7. In the sham group, the ureter was untouched; in the partial group, the ureter was gently embedded into the psoas muscle; and in the complete group, the ureter was compathologically, and all parameters were statistically evaluated.

Results: IMA was significantly associated with functional changes, creatinine values, and pathology scores (r = -0.729, r = 0.771, r = 0.827 respectively; p < 0.001). The postoperative IMA values of the partial and complete group were significantly higher than the respective preoperative values (p < 0.001, p < 0.001; p < 0.05, respectively). Additionally, the postoperative IMA values of the complete group were significantly higher than that of the sham and partial groups (p < 0.001, p = 0.001; p < 0.05, respectively).

Conclusions: IMA, which is strongly associated with renal functional and pathological variations, appears to be a valuable parameter for predicting renal injury and may warn clinicians before the irreversible phases of obstructive uropathy occur. More extensive studies with human participants may prove advantageous.

Objetivos: Este estudio intenta determinar la habilidad de la albumina modificada por la isquemia (IMA) para predecir el daño renal a través de asociar hallazgos patológicos, funcionales y bioquímicos con distintos grados de obstrucción.MÉTODOS: Se randomizaron 24 ratas en 3 grupos y se recogió su sangre para determinar la creatinina y IMA. Se realizó un renograma al inicio y en el día 7 del postoperatorio. En el grupo control, el uréter no se tocó, en el grupo parcial, el uréter se cosió en parte al músculo psoas y en el grupo completo el uréter se ligó completamente. La extensión de la lesión renal se graduó desde el punto de vista histológico, y todos los parámetros fueron estadísticamente evaluados.

Resultados: IMA estuvo estadísticamente asociada a cambios funcionales, valores de creatinina y grados histológicos (r = -0,729, r = 0,771, r = 0,827 respectivamente; p < 0,001). Los valores IMA postoperatorios en los grupos parcial y completa fueron significativamente más altos en relación a los valores preoperatorios (p < 0,001, p < 0,001; p < 0,05, respectivamente). Adicionalmente, los valores postoperatorios de IMA del grupo de obstrucción completa fueron significativamente más altos que el grupo control y parcial (p < 0,001, p = 0,001; p < 0,05, respectivamente).

Conclusiones: IMA, que está ampliamente asociado a la función renal y a las variaciones histológicas, parece ser un parámetro importante para predecir el daño renal y puede advertir a los clínicos antes de que se den las fases irreversibles de la uropatía obstructiva.Estudios más amplios con humanos pueden resultar ventajosos.

Keywords: Albumina modificada por la isquemia; Biomarcadores; Biomarkers; Escintigrafia; Estrés oxidativo; Hidronefrosis; Hydronephrosis; Ischemia-modified albumin; Oxidative stress; Scintigraphy.

Background: Hypertension (HTN) is one of the leading causes of morbidity and mortality worldwide. A prompt diagnosis and treatment of hypertensive retinopathy (HR), the leading complication of HTN is pivotal for a better visual outcome. Increased blood pressure on its own cannot fully clarify the development of retinal alterations, therefore an additional pathogenetic mechanism, such as oxidative stress, might be inquired.The aim of the study was to evaluate the changes in the level of ischemia modified albumin (IMA) in the serum and tears of HR patients in order to establish the predictive value of IMA for the HR progression.

Methods: Serum and tear samples for the measurement of IMA were collected from 90 patients detected primarily with HR, who were not taking any antihypertensive or other drug that could influence the results of the study, divided according to the Keith-Wagener classification into GI - 36 patients with HR grade I, GII - 35 with HR grade II and GIII - 19 with HR grade III. Serum and tear IMA levels were assessed using the Co²⁺ binding method and expressed as median and interquartile range. Kruskal-Wallis and Mann-Whitney nonparametric tests were used to compare the groups and the Spearman correlation coefficient was calculated (SPSS 23.0), with p<0.05 being statistically significant.

Results: The groups showed a statistically significant difference in serum IMA (p=0.006), the values increasing in parallel with the progression of HR. The serum IMA level in GII increased compared to GI (+3%; 239.06 μM/L (IQR 75.58) vs 231.77 μM/L (IQR 104.09), p=1.00), as well as in GIII patients compared to GII (+17%; 277.67 μM/L (IQR 88.72) vs 239.06 μM/L (IQR 75.58), p=0.04). There were no differences in IMA content (p=0.160), between groups in the tears. No correlations were found between serum and tear IMA levels (p=0.134), but serum IMA showed a significant moderate strength, positive correlation with the degree of HR (r=0.307, p=0.003).

Conclusion: A progressive enhancement in serum IMA level as HR advanced was identified. Thereby, the results suggest the potential relevance of serum IMA as a sensitive and early biomarker useful for grading and optimal treatment of the patients with HR.

Keywords: biomarker; hypertensive retinopathy; ischemia modified albumin; oxidative stress.

Introduction: This study investigated the status of serum ischaemia-modified albumin (IMA) levels in the development of diabetic foot ulcer (DFU) in patients with diabetes mellitus (DM) and in predicting ulcer formation and ulcer grading.

Materials and method: Thirty patients with DM, 30 with DFU and 30 healthy controls were included in the study. All participants' demographic characteristics and serum IMA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) levels and DFU infection grades were recorded.

Results: Nine (30%) patients with DFU were grade 2 according to the grading of International Working Group of the Diabetic Foot, 14 (46.7%) were grade 3 and seven (23.3%) were grade 4. Significant, powerful and positive correlation was determined between serum IMA and albumin-adjusted IMA levels and degrees of DFU (r = 0.878 and r = 0.846, P < .001 for both). Serum IMA levels in the DFU group were significantly higher than in the DM and control groups (P < .001). The optimal cut-off values for IMA in predicting DFU was 23.5 ng/mL (sensitivity 96%, specificity 87% and AUC = 0.97, P < .001). Additionally, at a cut-off value of 20.6 ng/mL, serum albumin-adjusted IMA differentiated cases of DFU from healthy individuals with 90% sensitivity and 83% specificity (AUC = 0.95, P < .001) Serum IMA levels exhibited significant, positive correlation with CRP, ESR, WBC, fasting plasma glucose and HbA1c (r = 0.575, r = 0.592, r = 0.597, r = 0.68 and r = 0.74, respectively, P < .001). Serum albumin levels were significantly negatively correlated with IMA, CRP, ESR and WBC values (r = -0.49, r = -0.56, r = -0.62 and r = -0.53, respectively, P < .001).

Conclusion: Our study findings indicate that together with CRP, ESH, WBC and albumin, increased IMA levels in patients with DM can be useful in the early prevention of DFU development and in predicting the severity of DFU infection.

Objectives: Epilepsy is one of the most common neurological disorders, diagnosis of which is challenging as many unrelated conditions may mimic seizure. Epilepsy impairs the quality of life of patients due to associated physical and psychological trauma. Epileptic patients are also at increased risk of premature death due to autonomic disturbance and fatal accidents. The aim of the present research work was to study ischemia modified albumin (IMA) as an early biomarker of epilepsy in the adolescent population.

Methods: Twenty-five diagnosed cases of epilepsy and 25 healthy volunteers as control of adolescent group were recruited as study subjects. The study subjects were age and sex matched. Clinical evaluation, routine biochemical parameters and IMA estimation were carried out. Serum IMA was measured by spectrophotometric method.

Results: The mean serum IMA levels were significantly raised in epileptic patients (0.69 ± 0.1 absorbance units [ABSU]) as compared to the healthy control group (0.52 ± 0.24 ABSU) (p=0.004). ROC curve of IMA predicted that at cut off of 0.59 ABSU, the IMA has 96% sensitivity and 52% specificity for diagnosing epilepsy.

Conclusions: IMA may be used as a biomarker for early diagnosis of epilepsy as well as to differentiate epileptic seizure from various non epileptic disorders in the adolescent population.

Keywords: adolescent; albumin; epilepsy; hypoxia; ischemia; oxidative stress.

Background: Mechanical bowel obstruction (MBO) is one of the principal pathologies requiring emergency surgery and a significant worldwide cause of morbidity. The identification of patients in whom bowel obstruction resolves spontaneously is important in terms of preventing unnecessary surgical interventions and future potential adhesions. The decision-making process is difficult in patients presenting without classic examination findings.

Methods: 36 female Sprague-Dawley rats randomly divided into six experimental groups. In Group 1, 3 and 5, laparotomy was performed, with blood and tissue specimens being collected after 1, 2 and 6 h, respectively. In Group 2, 4 and 6, the ileum segment was ligated following laparotomy, and blood and tissue specimens were collected after 1, 2 and 6 h, respectively. The ileum specimens were examined macroscopically, after which 1-cm sections were taken and examined in terms of histopathological changes. IMA and SCUBE-1 levels were determined for each group, and macro- and microscopic tissue examination findings were compared between the groups.

Results: Comparison within the groups exposed to waiting times of 1 h (groups 1 and 2), 2 h (groups 3 and 4) and 6 h (groups 5 and 6) revealed higher mean IMA and SCUBE-1 levels in rats undergoing ligation together with incision (groups 2, 4, and 6) compared to those undergoing laparotomy only (groups 1, 3, and 5). Correlation analysis was applied to determine the relationship between total scores obtained from histopathological examination and IMA and SCUBE-1 values. The analysis revealed strong, significant and positive correlation between histopathological examination scores and IMA (r=0.643, p=0.000) and SCUBE-1 (r=0.509, p=0.002) values.

Conclusion: The study findings showed that both IMA and SCUBE-1 values increased in a strangulated MBO model in rats. We think that IMA and SCUBE-1 values can be used as a markers of damage in the early period in strangulated MBO, and that the patient's surgery requirement can thus be determined in the early period.

Keywords: IMA; Mechanical bowel obstruction; SCUBE-1; strangulation.

Objective: Growing evidence shows that oxidative stress plays an important role in the development and progression of nephrotic syndrome (NS). In this study, we aimed to examine serum IMA levels as an indicator of oxidative stress in children with steroid-sensitive NS (SSNS) in remission and relapse.

Methods: This cross-sectional study was carried out at the Pediatric Nephrology Unit of Sanliurfa Training and Research Hospital, Sanliurfa, Turkey, from April 2019 to December 2019. In this study Serum IMA and albumin levels were determined in 70 children with SSNS and 45 healthy controls. Among the children with SSNS, 50 were in remission and 20 were in relapse. Then, adjusted IMA levels were calculated from the IMA/albumin ratio.

Results: IMA and adjusted IMA levels significantly increased and albumin significantly decreased in children with SSNS in relapse and remission compared with those of the healthy controls. Moreover, these alterations were more prominent in the relapse group than in the remission group. IMA was inversely correlated with albumin in children with SSNS (r= -0.881, p= <0.001).

Conclusions: Our findings demonstrated that elevated IMA and adjusted IMA levels observed in patients with SSNS were associated with increased oxidative stress and could indirectly reflect the degree of oxidative damage in glomerular structures.

Keywords: Ischemia modified albumin; Oxidative stress; Steroid-sensitive nephrotic syndrome.

BACKGROUND

We evaluated albumin cobalt binding (ACB) assay also known as Ischaemia Modified Albumin (IMA) assay as a prognostic marker for severe malaria in a medical college setting.

METHODS

Consecutive adult patients admitted with both vivax and falciparum malaria were evaluated with ACB assay at the time of admission. Detailed work up and individual patient directed management were instituted in addition to immediate artemisin based antimalarial therapy.

RESULTS

100 consecutive patients (50 with vivax and 50 with falciparum malaria) were evaluated. The reference range for ACB assay was established using 50 adult healthy (25 male and 25 female) individuals. 16 out of 50 p. Falciparum-Infected developed complicated malaria. None of the P Vivax patients developed complicated malaria. All malaria infected patients had high ACB levels (P<0.0001). There was a stepwise increase in ACB levels from healthy volunteers to different categories of malaria (P<0.0001) without any overlap.

CONCLUSIONS

ACB has the potential to be used as a robust simple and inexpensive prognostic marker for organ dysfunction in severe malaria even if an evaluation at multiple sites with a bigger number of patients should be initiated for final recommendation.

Aim: Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. Chronic inflammatory conditions and increased oxidative stress are in the pathogenesis of sarcopenia. Our aim was to evaluate the relationship between sarcopenia and thiol-disulfide homeostasis and ischemia-modified albumin levels as an oxidative stress marker.

Methods: Patients aged ≥65 years were recruited in this study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criterion. Total thiol, native thiol, disulfide and ischemia-modified albumin levels were measures according to clinical and laboratory features. Patients were divided into two groups according to their sarcopenia presence; thiol-disulfide homeostasis and ischemia-modified albumin levels were evaluated between these groups.

Results: Overall, 94 patients were analyzed. The mean age was 75.0 ± 6.71 years. A total of 39% of the patients were diagnosed as probable sarcopenia, 3.2% had sarcopenia, 6.4% had severe sarcopenia and 51.1% were diagnosed as normal. The levels of native thiol, total thiol, disulfide level and disulfide-native thiol, native thiol-total thiol and disulfide-total thiol ratios were similar in patients with sarcopenia when compared with the control group. In addition, there were no differences between albumin and ischemia-modified albumin levels. In univariate regression analysis, handgrip strength was found to be an independent predictor of native thiol and total thiol, and disulfide levels.

Conclusion: This is the first study in the literature that evaluates the thiol-disulfide homeostasis and ischemia-modified albumin levels in sarcopenic older patients. Long-term studies are warranted to confirm the relationship between oxidative stress markers and sarcopenia. Geriatr Gerontol Int 2021; ••: ••-••.

Keywords: geriatric assessment; inflammatory markers; older patients; oxidative stress; sarcopenia.

Background: The early detection and treatment of sepsis and septic shock patients in emergency departments are critical. Ischemia modified albumin (IMA) is a biomarker produced by ischemia and oxygen free radicals which are related to the pathogenesis of sepsis-induced organ dysfunction. This study aimed to investigate whether IMA was associated with short-term mortality in quick sequential organ failure assessment (qSOFA)-positive sepsis or septic shock patients screened by the sepsis management program.

Method: From September 2019 to April 2020, patients who arrived at the emergency departments with qSOFA-positive sepsis or septic shock were included in this retrospective observational study.

Results: Among 124 patients analyzed, IMA was higher in the non-surviving group than in the surviving group (92.6 ± 8.1 vs. 86.8 ± 6.2 U/mL, p < 0.001). The area under the receiver operating characteristics curve was 0.703 (95% CI: 0.572-0.833, p < 0.001). The optimal IMA cutoff was 90.45 (sensitivity 60.9%, specificity 79.2%). IMA values were independently associated with 28-day mortality in the multivariate Cox proportional hazard model (adjusted hazard ratio (aHR) = 1.16, 95% CI: 1.06-1.27, p < 0.01).

Conclusions: In this study, we showed that IMA in the emergency departments was associated with 28-day mortality in qSOFA-positive sepsis and septic shock patients. Further studies are needed to evaluate the clinical value of IMA as a useful biomarker in large populations and multicenter institutions.

Keywords: Emergency department; Ischemia modified albumin; Mortality; Sepsis; Septic shock.

Infants with respiratory distress syndrome (RDS) may suffer from severe hypoxia, asphyxia. In this study, we aimed to evaluate serum ischemia-modified albumin (IMA) level as a diagnostic marker for hypoxia in preterm infants with RDS. Thirty-seven premature newborns with RDS were allocated as the study group and 42 healthy preterm neonates were selected as the control group. IMA was measured as absorbance unit (ABSU) in human serum with colorimetric assay method which is based on reduction in albumin cobalt binding. IMA levels were significantly higher in neonates with RDS as compared to the control group (P < 0.001). Cut-off value of IMA (ABSU) was 0.72, the sensitivity level was 91.9 %, the specificity was 78.6 %, positive predictive value was 79.1 % and negative predictive value was 91.7 % at RDS. Area under curve values was 0.93 (P < 0.001; 95 % CI, 0.88-0.98) in the receiver operating characteristic curve. We concluded that elevated blood IMA levels might be accepted as a useful marker for hypoxia in newborn with RDS.

Verification of the diagnosis of coronary artery disease (CAD) is based mostly on instrumental diagnostic techniques. Presently, there are no laboratory tests officially recommended for the diagnostics of myocardial ischemia (MI). Biochemical methods that would be able to verify MI in patients with suspected CAD have been under development since the 1990s. Ischemically modified albumin--IMA (Albumin Cobalt Binding test), glycogen phosphorylase BB, and free fatty acid-binding protein have been proposed as laboratory markers of MI. The article discusses advantages and disadvantages of IMA for diagnostics of MI in patients with acute coronary syndrome.

BACKGROUND

In this article, we aimed to determine the diagnostic role of ischemia-modified albumin (IMA) in the evaluation of patients with deep venous thrombosis (DVT).

METHODS

Fifty-five patients with a diagnosis of DVT and 47 healthy subjects as the control group were included in the study. Blood samples of the patients were obtained within the first 24 hours after DVT diagnosis for IMA analysis. Patient and control groups were compared with respect to IMA levels.

RESULTS

We found that HDL and albumin levels were significantly higher in the control group. However, we could not determine a significant increase in IMA levels in patients with DVT when compared to the control group.

CONCLUSIONS

Our study revealed that IMA is not a useful marker in the diagnosis of DVT.

Background: Telogen effluvium is the most common form of non-scarring alopecia characterized by diffuse hair loss. Ischemia-modified albumin is a marker of oxidative stress and inflammation.

Objective: The aim of this study was to compare the levels of ischemia-modified albumin of telogen effluvium patients with healthy controls.

Methods: Ninety-one patients diagnosed with telogen effluvium and 35 healthy volunteers were included in the study. Serum ischemia-modified albumin level was determined by a fast-colorimetric method, and albumin cobalt binding test. The results were evaluated statistically.

Results: There was no statistically significant difference between the serum albumin values of patient and control groups (p=0.739). Serum ischemia-modified albumin values were significantly higher in the patients with telogen effluvium than healthy controls (p<0.001).

Study limitations: Body mass index values of the patient and control groups could not be calculated.

Conclusions: To the best of the authors' knowledge, this is the first clinical study to investigate the role of oxidative stress in the pathogenesis of telogen effluvium using ischemia-modified albumin as a biomarker. Based on the results of the present study, it can be considered that oxidative stress plays an important role in the pathogenesis of telogen effluvium. There is a need for further studies to support the results of this study, to demonstrate the possible effects of oxidative stress, and to investigate the other oxidative stress markers in the pathogenesis of telogen effluvium.

Keywords: Alopecia; Inflammation; Oxidative stress.

UNASSIGNED

Oxidative stress has been implicated in several disorders, including acute pancreatitis (AP). Ischemia-modified albumin (IMA), which reflects the ability to bind cobalt, has been found to be elevated in conditions of oxidative stress and tissue hypoxia. This study examined IMA and adjusted IMA levels in patients with AP, and examined the associations of IMA and adjusted IMA levels to the severity of AP.

UNASSIGNED

A total of 42 consecutive patients with AP and 43 age- and sex-matched control subjects were enrolled. Serum samples were obtained from patients with AP on admission as well as 48-72 hours after hospitalization, and from the controls, at the time of enrollment. Adjusted IMA was calculated by multiplying the IMA value of each patient with the ratio of the patient's albumin value and the median albumin value of the study population. The severity of AP was assessed according to the modified Atlanta classification, and the patients were divided into 2 groups: mild AP and severe AP.

UNASSIGNED

The serum IMA and adjusted IMA values of patients with AP on admission and those of the controls did not differ (p=0.86 and p=0.99, respectively). The second measurements of IMA and adjusted IMA in the AP group were higher than the first measurements of both the AP group and controls (for all, p<0.01). Among the IMA measurements, only adjusted IMA on admission had the ability to predict the severity of AP. Severe AP was correlated with albumin, and the area under the curve of adjusted IMA values on admission was 0.746 for differentiating patients with severe AP from mild AP with statistical significance (p=0.005).

UNASSIGNED

It was shown that IMA and adjusted IMA levels rise with the progression of AP. Lower levels of adjusted IMA predict the severity of AP. Further studies with serial measurements of IMA are warranted to explore the indicative role of IMA in the course of AP.

The red cell expansion in polycythemia vera (PV) causes hyperviscosity affecting blood flow, which plays a major role in the pathogenesis of both microcirculatory disturbances and ultimately thromboses. Ischemia-modified albumin (IMA) is produced during an ischemic states and is present in blood in early and easily detectable levels. This study investigated whether IMA is a useful adjunct in the determination of ischemia in patients with PV, prior to them exhibiting clinical evidence of thrombotic complications. Blood IMA levels were determined in 20 PV patients and in 20 healthy individuals using a method described by Bar-Or. Mean IMA levels in the PV group were significantly higher than those of the control group (P<0.05). At the optimum cutoff point (0.193 absorbance units), the sensitivity and specificity of IMA were 80 and 100% to ischemia, respectively. In conclusion, IMA may be a valuable biochemical marker in predicting tissue ischemia in PV before the signs of vascular disturbances occur.

Ischemia modified albumin (IMA) is a marker that has been determined to be elevated in hypoxic conditions. This study aimed to investigate the relationships between serum IMA and blood gas parameters (BGPs) and evaluate whether IMA can be used as a parameter clinically in terms of reflecting tissue hypoxia in ventilator management. BGPs and serum IMA level were measured in blood samples drawn simultaneously from patients. Mean serum IMA levels, mean pCO2, mean pO2, and lactate levels were 82.56 ± 25.47 ng/mL, 47.99 ± 22.81 mm Hg, 53.62 ± 30.43 mm Hg, and 2.13 ± 3.22 mmol/L, respectively. No correlation was found between serum IMA level and BGPs. Our findings showed that serum IMA level can be concluded not to be a suitable parameter in ventilator management. However, IMA can be a reliable guide if used together with venous BGPs in terms of the estimating of tissue oxygenation, especially within the last few hours.

OBJECTIVE

Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS).

METHODS

56 patients (23 F, 33 M; 56.04 ± 8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography.

RESULTS

The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not.

CONCLUSIONS

Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS.

BACKGROUND

Preliminary data indicate that B type natriuretic peptides' levels may rise in exercise induced myocardial ischemia in patients with stable coronary artery disease. Such findings hint at a potential broader application of these markers reaching beyond its present use in chronic heart failure and acute coronary syndromes. Ischemia modified albumin (IMA) is a novel diagnostic marker in acute coronary syndromes as its value increases in states of myocardial ischemia and necrosis. The role of this marker in the assessment of exercise induced myocardial ischemia in stable coronary artery disease has not been extensively investigated and remains unknown.

OBJECTIVE

To examine changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and ischemia modified albumin (IMA) during an ECG stress test in patients with stable coronary artery disease and to assess the potential of these markers to detect exercise induced myocardial ischemia.

METHODS

Patients with angiographically confirmed coronary atherosclerosis were included into the study. In all of them prognostic ECG stress test according to Bruce protocol was performed. The test was considered true positive (ischemia present) in case of significant ST-segment depression in the presence of significant coronary stenosis. The test was considered true negative (ischemia absent) when no significant ST depression was noted in the absence of significant coronary stenosis. In all patients echocardiography was performed and blood was drawn for NT-proBNP, IMA, serum albumin and creatinine before and within the first five minutes after exercise.

RESULTS

41 patients with unequivocal stress test result corresponding to coronary angiogram were included in the final analysis (out of 51 examined patients). 21 patients demonstrated ischemia during exercise, 20 did not. NT-proBNP concentration was significantly higher after the stress test than before in the whole group: 127.9 (10.7-994.2) pg/ml and 110 (10.5-990.2) pg/ml respectively; p < 0.0001. NT-proBNP increase was higher in the ischemic than in the non-ischemic group; however, the difference was not statistically significant: deltaNT-proBNP 12.3 (1.0-172.3) pg/ml and 4.2 (1.0-77.1) pg/ml respectively; p = 0.09. This manifested itself in poor sensitivity and specificity of NT-proBNP in detecting exercise induced myocardial ischemia: 62 and 55% respectively (AUC 0.589). In the whole group the increase of NT-proBNP depended on baseline NT-proBNP concentration (r = 0.54; p = 0.0003), the magnitude of ST-segment depression (r = 0.38; p = 0.01), creatinine concentration (r = 0.34; p= 0.03) and history of myocardial infarcion: log deltaNT-proBNP in post-MI patients and in patients without prior MI 1.19 ( +/- 0.54) i 0.61 ( +/- 0.57) respectively; p = 0.004. In multiple regression analysis the only factor independently determining NT-proBNP increase during exercise was the history of myocardial infarction (beta = 0.342; p = 0.01) but not left ventricle ejection fraction. IMA decreased during exercise in all patients significantly--the mean value before and after exercise was 88.20 (7.72) and 78.05 (8.33) U/ml respectively; p = 0.0001. Decrease in IMA correlated only with increase in albumin concentration measured before and after exercise (r = -0.6; p < 0.0001).

CONCLUSIONS

Exercise induced myocardial ischemia has little influence on NT-proBNP increase. The test measuring it has therefore insufficient ability to detect exercise induced ischemia in stable coronary artery disease. In patients with stable coronary artery disease without severe impairment of left ventricular function the history of myocardial infarction is the main factor determining NT-proBNP increase during exercise. Changes in serum albumin concentration during exercise seem to exclude the use of IMA in the assessment of exercise induced myocardial ischemia.

OBJECTIVE

The objectives were to determine the diagnostic value of blood ischemia-modified albumin (IMA) levels in experimentally induced carbon monoxide (CO) poisoning and to analyze their correlation with poisoning severity.

METHODS

Thirty-six female rats were randomly assigned to one of three groups: I (control group), II (low-dose CO poisoning group), and III (high-dose CO poisoning group). The control group was kept in room air, while groups II and III were exposed to 3 L/min of 3,000 ppm and 3 L/min of 5,000 ppm CO gas for 30 minutes, respectively. Serum carboxyhemoglobin (COHb), IMA, and malondialdehyde (MDA) levels; brain, heart, lung, liver, and kidney tissue MDA measurements; and histopathologic damage scores were then compared.

RESULTS

IMA levels were significantly higher in groups II and III than in group I. A moderate positive correlation was observed between COHb and IMA levels. There was a strong positive correlation between COHb levels and degree of damage in all organs, but IMA and MDA levels did not reflect a similar correlation.

CONCLUSIONS

Ischemia-modified albumin levels are higher in rats exposed to CO. This indicates that IMA levels can potentially be important in the diagnosis of exposure to CO or of CO poisoning. However, IMA levels are not a good biochemical marker in terms of determining the severity of poisoning.

BACKGROUND

Ischemia-modified albumin (IMA) is a systemic indicator of inflammatory diseases and is suggested as an oxidative stress marker.

OBJECTIVE

To determine the IMA and high-sensitivity C-reactive protein (hsCRP) serum levels for patients with chronic periodontitis (CP) and to evaluate the impact of non-surgical periodontal therapy on serum IMA and hsCRP levels.

METHODS

Twenty one systemically healthy patients with CP and 15 systemically and periodontally healthy controls (C) were enrolled in the study. Periodontal pocket depth (PPD), bleeding on probing (BOP) and attachment loss (AL) were recorded at the time of diagnosis and 6 weeks after the non-surgical periodontal therapy. Blood samples were obtained before and after treatment from all groups, and serum IMA and hsCRP levels were evaluated by ELISA method.

RESULTS

All of the clinical findings were found to be elevated in the CP group in comparison to C group (p<0.05). Levels of IMA and hsCRP were higher in the CP group (p<0.05) and decreased after non-surgical periodontal therapy (p<0.05). Positive correlations were determined between PPD, BOP and hsCRP (p<0.05) as well as between PPD, AL, BOP and IMA levels (p<0.01) before treatment. A significant positive correlation was also observed between hsCRP and IMA (p<0.01) before and after treatment.

CONCLUSIONS

IMA is a marker indicating systemic inflammation during periodontal disease, and significantly reduced as a result of non-surgical periodontal therapy. Therefore, IMA might be suggested as a useful indicator of periodontal disease.

Background: Severe acute pancreatitis (SAP) is characterized by the noxious combination of severe systemic inflammation and hypoperfusion and oxidative stress. Ischemia-modified albumin (IMA) was recognized as a novel marker of oxidative stress and ischemia. The purpose of this study was to evaluate serum IMA level in patients with SAP and analyze its prognostic significance. Methods: A total of 72 patients with SAP were enrolled. Serum IMA level was measured within 24 hours of the onset of SAP, and baseline characteristics were recorded. The BISAP, APACHE II and SOFA scores were calculated. Multivariate logistic regression and receiver operating characteristic curve analyses were used to evaluate predictive ability of LMA for in-hospital mortality of SAP. Kaplan-Meier analysis was further used to compare in-hospital mortality difference between high LMA and low LMA. Results: The overall in-hospital mortality rate of all 72 SAP patients was 23.6%. Non-survivor group had higher serum IMA (107.2±10.8 VS 88.4±11.9, P<0.05) than survivor group. Otherwise, the optimal cutoff levels for the IMA predicting in-hospital mortality of patients with SAP was 112 U/ml using a sensitivity of 77.4% and a specificity of 76.2% as optimal conditions (AUC, 0.734; 95% CI: 0.615-0.852; P=0.002). IMA level also was confirmed as an independent prognostic factor for SAP in multivariate analysis. Patient with high IMA level (≥112 U/ml) had poorer survival rate than low IMA (<112 U/ml) in log-rank test of Kaplan-Meier survival analysis (P<0.05). Conclusions: Serum IMA level can be considered as an independent predictor for in-hospital mortality of patients with SAP.