DIAGNOSIS OF MYOCARDIAL ISCHEMIA USING PLASMA FREE FATTY ACID AS A BIOMARKER
Objective: Diagnosis of myocardial ischemia (MI) in patients attending emergency intensive care unit (ICU) with symptoms of an acute coronary
disease is often difficult. Biochemical markers such as cardiac troponin (cTn) and creatinine kinase MB (CK-MB) may not rise during reversible MI.
Previous studies suggest unbound free fatty acid (FFA) increased significantly in ischemic related events. Thus, plasma FFA has shown to be an early
biochemical marker. To diagnose MI using plasma FFA as a biomarker.
Methods: Blood samples were collected from 30 ischemic heart disease (IHD) patients admitted to ICU and 30 healthy volunteers for plasma FFA.
Patients were diagnosed as IHD based on the clinical presentation, electrocardiogram (ECG), and coronary angiography findings, cTn, CK-MB. Plasma
FFA was measured enzymatically with (acyl-CoA synthetase- acyl-CoA oxidase) non-esterified fatty acid kit (Randox Laboratories Ltd., Co.Antrium,
United Kingdom) on Bayer RA 50 analyzer in both normals and IHD patients.
Results: Around 93.3% of the patients presented with the chest pain as a major symptom and 6.7% of the patient presented with dyspnea. All
the patients showed a positive ECG change and angiographic findings suggestive of IHD. Plasma FFA (1.134Â±0.21) in IHD was significantly higher
(p<0.0001) than the control (0.5233Â±0.13). With respect to lipid profile triglycerides, low-density lipoprotein (LDL), very LDL was significantly higher
in MI when compared to normal with p<0.001, whereas HDL was significantly higher in normals than the study group with p<0.05. There was no
statistical difference in total cholesterol and hemoglobin value between the study group and the normals. Further standard biomarker like cTn was
elevated in 60% (18) and CK-MB in 63% (19) of the patients when compared to FFA, which was elevated in 86% (26) of the patients.
Conclusion: Thus, plasma FFA can be used as a simple, quick, and early marker of MI. However, should FFAs be measured routinely as a standard
diagnostic marker of ischemia still warrants further studies?
Keywords: Myocardial ischemia, plasma FFA, cardiac troponin, creatinine kinase MB
Nomenclature and criteria for diagnosis of ischemic heart disease.
Report of the Joint International Society and Federation of Cardiology/
World Health Organization Task Force on Standardization of Clinical
Nomenclature. Circulation 1979;59(3):607-9.
Myocardial Infarction Redefined â€“ A Consensus Document of The
Joint European Society of Cardiology/American College of Cardiology
Committee for the redefinition of myocardial infarction. Eur Heart J
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD,
Hochman JS, et al. ACC/AHA guidelines for the management of
patients with unstable angina and non-ST-segment elevation myocardial
infarction: A Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines (Committee on
the Management of Patients With Unstable Angina). J Am Coll Cardiol
Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW,
McFadden E, et al. Management of acute coronary syndromes in
patients presenting without persistent ST-segment elevation. Eur Heart
Panteghini M, Pagani F, Bonetti G. The sensitivity of cardiac markers:
An evidence-based approach. Clin Chem Lab Med 1999;37(1112):1097-106.
Panteghini M. Acute coronary syndrome: Biochemical strategies in the
troponin era. Chest 2002;122(4):1428-35.
Dawie J, Chawla R, Worku Y, Azazh A. Diagnosis of ischemic heart
disease using CK-MB, troponin-I and ischemia modified albumin.
Ethiop Med J 2011;49(1):25-33.
Goel PK, Bharti BB, Pandey CM, Singh U, Tewari S, Kapoor A,
et al. A tertiary care hospital-based study of conventional risk factors
including lipid profile in proven coronary artery disease. Indian Heart J
Hamm CW, Bertrand M, Braunwald E. Acute coronary syndrome
without ST elevation: Implementation of new guidelines. Lancet
Borensztajn J, Brewer HB, Coppack SW, Hussain MM, Kaikans RM,
Bass NM, et al. Lipid transport and storage. In: Murray RK, Granner
DK, Mayes PA, Rodwell VW, editors. Harperâ€™s Biochemistry. 25
New York: McGraw Hill. 2000.
Asian J Pharm Clin Res, Vol 8, Issue 6, 2015, 77-80
Prabhavathi et al.
Pirro M, MauriÃ¨ge P, Tchernof A, Cantin B, Dagenais GR, DesprÃ©s JP,
et al. Plasma free fatty acid levels and the risk of ischemic heart disease
in men: Prospective results from the QuÃ©bec Cardiovascular Study.
Gupta M, Lent RW, Kaplan EL, Zabriskie JB Serum cardiac troponin I
in acute rheumatic fever. Am J Cardiol 2002;89(6):779-82.
Dispenzieri A, Kyle RA, Gertz MA, Therneau TM, Miller WL,
Chandrasekaran K, et al. Survival in patients with primary
systemic amyloidosis and raised serum cardiac troponins. Lancet
Missov E, Mentzer W, Laprade M. Cardiac markers of injury in
hemoglobinopathy patients with transfusion hemosiderosis. J Am Coll
Mutch WJ, Kulkarmi UV, Croal BL. Cardiac marker levels in
hypothyroidism. Clin Chem 2001;47 Suppl:A199.
Jesse RL. Rationale for the early clinical application of markers of ischemia
in patients with suspected acute coronary syndromes. In: Wu AH, editor.
Cardiac Markers. 2
ed. Totowa, NJ: Humana Press; 2003. p. 245-57.
Morrow DA, de Lemos JA, Sabatine MS, Antman EM. The search for
a biomarker of cardiac ischemia. Clin Chem 2003;49(4):537-9.
Kleinfeld AM, Prothro D, Brown DL, Davis RC, Richieri GV,
DeMaria A. Increases in serum unbound free fatty acid levels following
coronary angioplasty. Am J Cardiol 1996;78(12):1350-4.
Pilz S, Scharnagl H, Tiran B, Wellnitz B, Seelhorst U, Boehm BO, et al.
Elevated plasma free fatty acids predict sudden cardiac death: A 6.85year
Oliver MF. Sudden cardiac death: The lost fatty acid hypothesis. QJM
Hufnagel B, Dworak M, Soufi M, Mester Z, Zhu Y, Schaefer JR, et
al. Unsaturated fatty acids isolated from human lipoproteins activate
protein phosphatase type 2Cbeta and induce apoptosis in endothelial
cells. Atherosclerosis 2005;180(2):245-54.
Schaefer JR, Klumpp S, Maisch B, Krieglstein J. Why does atherosclerosis
occur where it occurs? Atherosclerosis 2005;180(2):417-8.
Opie LH. The metabolic vicious cycle in heart failure. Lancet
Davda RK, Stepniakowski KT, Lu G, Ullian ME, Goodfriend TL,
Egan BM. Oleic acid inhibits endothelial nitric oxide synthase
by a protein kinase C-independent mechanism. Hypertension
Tripathy D, Mohanty P, Dhindsa S, Syed T, Ghanim H, Aljada A, et al.
Elevation of free fatty acids induces inflammation and impairs vascular
reactivity in healthy subjects. Diabetes 2003;52(12):2882-7.
Chiu HC, Kovacs A, Blanton RM, Han X, Courtois M, Weinheimer CJ,
et al. Transgenic expression of fatty acid transport protein 1 in the heart
causes lipotoxic cardiomyopathy. Circ Res 2005;96(2):225-33.
Stepniakowski KT, Goodfriend TL, Egan BM. Fatty acids enhance
vascular alpha-adrenergic sensitivity. Hypertension 1995;25:774-8.
Haddad FH, Omari AA, Shamailah QM, Malkawi OM, Shehab AI,
Mudabber HK, et al. Lipid profile in patients with coronary artery
disease. Saudi Med J 2002;23(9):1054-8.
Frayn KN. Plasma non-esterified fatty acids: Why are we not measuring
them routinely? Ann Clin Biochem 2005;42:413-4.
How to Cite
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.