Biomarkers in Acute Cardiac Care - Visualization of myocardial necrosis in non-ST-elevation acute coronary syndrome

急性心脏护理中的生物标志物 - 非 ST 段抬高急性冠脉综合征心肌坏死的可视化

• 批准号: 514575804
• 负责人: Professor Dr. Kai Müllerleile
• 金额: --
• 依托单位: Universitäres Herz- und Gefäßzentrum Hamburg (UHZ)
• 依托单位国家: 德国
• 项目类别: Research Grants
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/514575804?language=en
• 关键词: Biomarkers; Acute; Cardiac; Care; Visualization

Acute chest pain as the leading symptom of myocardial ischemia belongs to the most frequent reasons of consultation in emergency medical care. Diagnostic algorithms for management of patients with suspected myocardial infarction evolved in recent years. Especially the introduction of modern high-sensitivity troponin assays lead to more rapid protocols with highly sensitive decision cutoffs, enabling accurate rule-out of myocardial infarction (MI) early after presentation to the emergency department. Diagnostic studies evaluating patients with suspected acute MI entail a major limitation: The diagnosis of MI, especially non-ST-elevation acute coronary syndrome (NSTE-ACS), is by definition a biomarker-based diagnosis. Thus, it is a typical clinical and scientific problem to discriminate “truly”, acute ischemic coronary events (type 1 MI) from other conditions with elevated cardiac blood biomarkers (acute myocardial injury or type 2 MI) caused by underlying diseases like congestive heart failure or hypertensive crisis. The central hypothesis of the Biomarkers in Acute Cardiac Care - Visualization of myocardial necrosis in non-ST-elevation acute coronary syndrome (BACC-VISION) study is that diagnostic algorithms in non-ST-elevation acute coronary syndrome (NSTE-ACS) can be improved by readjusting biomarker thresholds according to a “gold standard" diagnosis defined by cardiac magnetic resonance imaging (CMR) and thus reduce unnecessary and potentially harmful invasive diagnostics. For the first time, CMR will be performed in the acute phase of NSTE-ACS – before angiography is performed. With this unique approach the early phase of MI will be assessed by CMR without the influence of periprocedural myocardial injury due to coronary revascularization. A second hypothesis is that the biomarker-based discrimination of type 1 and type 2 MI can be improved by defining an unequivocal, CMR-based definition of type 1 MI. The differentiation of type 1 and type 2 MI is still an unmet scientific and clinical need and using the CMR-based gold standard definition of type 1 MI will allow to adjust diagnostic strategies to differentiate both types of MI. Additional targets are the assessment of the impact of revascularization on myocardial salvage and functional recovery. Furthermore, the study will assess the ability of current ECG and echocardiography-based approaches to predict “culprit” lesions defined by coronary angiography (including intravascular imaging such as OCT and IVUS) in combination with CMR as reference. Due to pre- and postprocedural CMR imaging BACC-Vision will enable analyzing frequency and prognostic implications of periprocedural myocardial injury in NSTE-ACS patients, which are unclear at the moment.

急性胸痛作为心肌缺血的主要症状，是急诊医疗中最常见的就诊原因。近年来，用于管理疑似心肌梗塞患者的诊断算法不断发展。特别是现代高灵敏度肌钙蛋白检测的引入导致了更快速的方案和高度敏感的决策截止值，从而能够在急诊室就诊后尽早准确排除心肌梗塞（MI）。评估疑似急性心肌梗死患者的诊断研究存在一个主要局限性：心肌梗死的诊断，特别是非 ST 段抬高的急性冠状动脉综合征 (NSTE-ACS)，根据定义是基于生物标志物的诊断。因此，如何区分“真正的”急性缺血性冠状动脉事件（1 型心肌梗死）与由充血性心力衰竭或高血压危象等基础疾病引起的心脏血液生物标志物升高的其他病症（急性心肌损伤或 2 型心肌梗死）是一个典型的临床和科学问题。急性心脏护理中的生物标志物 - 非 ST 段抬高型急性冠脉综合征 (BACC-VISION) 中心肌坏死的可视化研究的中心假设是，根据心脏磁学定义的“金标准”诊断重新调整生物标志物阈值，可以改进非 ST 段抬高型急性冠脉综合征 (NSTE-ACS) 的诊断算法。 磁共振成像（CMR），从而减少不必要的和潜在有害的侵入性诊断。 CMR 将首次在 NSTE-ACS 急性期进行，即在进行血管造影之前。通过这种独特的方法，心肌梗死的早期阶段将通过 CMR 进行评估，而不会受到冠状动脉血运重建导致的围手术期心肌损伤的影响。第二个假设是，通过定义基于 CMR 的 1 型 MI 的明确定义，可以改善对 1 型和 2 型 MI 的基于生物标志物的区分。区分 1 型和 2 型 MI 仍然是一个未满足的科学和临床需求，使用基于 CMR 的 1 型 MI 黄金标准定义将允许调整诊断策略以区分这两种类型的 MI。其他目标是评估血运重建对心肌挽救和功能恢复的影响。此外，该研究还将评估当前基于心电图和超声心动图的方法预测冠状动脉造影（包括 OCT 和 IVUS 等血管内成像）定义的“罪魁祸首”病变的能力，并结合 CMR 作为参考。由于术前和术后 CMR 成像，BACC-Vision 将能够分析 NSTE-ACS 患者围手术期心肌损伤的频率和预后影响，目前尚不清楚。