Korean Circ J.  2014 Jan;44(1):10-15. 10.4070/kcj.2014.44.1.10.

Myeloperoxidase Is Not Useful for Detecting Stress Inducible Myocardial Ischemia but May Be Indicative of the Severity of Coronary Artery Disease

• Schuhmann
• Hacker M
• Jung P
• Krotz F
• Sohn HY

• KMID: 1859236
• DOI: http://doi.org/10.4070/kcj.2014.44.1.10

Abstract

BACKGROUND AND OBJECTIVES
Elevated levels of myeloperoxidase (MPO) have been found in patients in different stages of coronary artery disease (CAD). The aim of this study was to assess whether the MPO liberation is increased by stress inducible myocardial ischemia and could be used to improve the diagnostic accuracy of non-invasive evaluation for myocardial ischemia.
SUBJECTS AND METHODS
Seventy-six patients with suspected myocardial ischemia who underwent stress myocardial perfusion scintigraphy (MPS) were enrolled. 59 patients with an acute coronary syndrome (ACS) who received a percutaneous coronary intervention along with 12 healthy volunteers were also included in the study. In every subject the MPO plasma levels were assessed by enzyme linked immunosorbent assay. In patients undergoing MPS, the MPO levels were measured serially before and after the stress testing.
RESULTS
Of the 76 patients undergoing MPS, 38 were diagnosed with a stress inducible myocardial ischemia. The patients with a stress induced ischemia had significantly higher basal MPO levels than those without it (32+/-3 ng/mL vs. 24+/-4 ng/mL, p=0.03). However, there was no relevant change in the MPO levels after the stress test compared to the baseline. The patients with ACS showed significantly higher MPO levels than the patients undergoing MPS (131+/-14 ng/mL vs. 28+/-2 ng/mL, p<0.01) and the healthy subjects (131+/-14 ng/mL vs. 26+/-2 ng/mL, p<0.01).
CONCLUSION
Since the MPO plasma levels did not increase after the stress MPS, MPO appears not to be a useful biomarker for detecting a stress inducible myocardial ischemia. Yet, the MPO levels correlate with the different stages of CAD and may hold significance as an indicator for its clinical severity.

Keyword

Myeloperoxidase; Coronary artery disease; Myocardial ischemia; Myocardial perfusion imaging; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome
Coronary Artery Disease*
Coronary Vessels*
Enzyme-Linked Immunosorbent Assay
Exercise Test
Healthy Volunteers
Humans
Ischemia
Myocardial Ischemia*
Myocardial Perfusion Imaging
Percutaneous Coronary Intervention
Perfusion Imaging
Peroxidase*
Plasma
Peroxidase

Figure

• 

  Fig. 1 Basal MPO plasma levels. The mean MPO plasma levels did not differ between the patients with a suspected haemodynamically relevant CAD undergoing MPS and the healthy subjects {28±2 ng/mL vs. (n=76) 26±2 ng/mL (n=12), p=0.75}. In the patients with angiographically confirmed CAD presented with ACS, the MPO levels were markedly elevated compared to the patients undergoing MPS {131±14 ng/mL (n=59) vs. 28±2 ng/mL (n=76), p<0.01} and the healthy subjects {131±14 ng/mL (n=59) vs. 26±2 ng/mL (n=12), p<0.01}, respectively. Denotes a statistic significant difference. MPO: myeloperoxidase, CAD: coronary artery disease, MPS: myocardial perfusion scintigraphy, ACS: acute coronary syndrome.

• 

  Fig. 2 MPO levels and stress induced myocardial ischemia in MPS. The MPO plasma levels were higher in the patients diagnosed with a stress inducible myocardial ischemia in MPS than in the patients without ischemia even before the stress testing was performed {32±3 ng/mL (n=38) vs. 24±4 ng/mL (n=38), p=0.03}. However, there was no significant change in the MPO plasma levels after MPS, neither in the patients without {24±4 ng/mL (n=38) vs. 24±3 ng/mL (n=38), p=0.55} nor in those with {32±3 ng/mL (n=38) vs. 31±3 ng/mL (n=38), p=0.87} a stress inducible ischemia. Denotes a statistic significant difference. MPO: myeloperoxidase, MPS: myocardial perfusion scintigraphy.

• 

  Fig. 3 MPO levels and extent of stress induced myocardial ischemia. Stress induced ischemia was analysed semi-quantitatively and expressed in volume % of the left ventricular (LV) myocardium. Three groups were defined: no relevant ischemia (ischemic volume <5% of LV myocardium), mild to moderate ischemia (5-10%), severe ischemia (>10%). The patients with a severe ischemia showed significantly higher MPO plasma levels both prior to and after the stress testing than the patients with no relevant stress inducible ischemia {37±5 ng/mL (n=16) vs. 26±2 ng/mL (n=44), p=0.03 and 36±5 ng/mL (n=16) vs. 25±2 ng/mL (n=44), p=0.03, respectively}. Again, there were no changes in the MPO levels detected after MPS, regardless of the extent of the myocardial ischemia {<5% (n=44): 26±2 ng/mL vs. 25±2 ng/mL, p=0.40; 5-10% (n=16): 24±4 ng/mL vs. 27±4 ng/mL, p=0.33; >10% (n=16): 37±5 ng/mL vs. 36±5 ng/mL, p=0.69}. Denotes a statistic significant difference. MPO: myeloperoxidase.

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