Project Details
Projekt
Biomarkers in Acute Cardiac Care - Visualization of myocardial necrosis in non-ST-elevation acute coronary syndrome
Applicants
Professor Dr. Kai Müllerleile; Dr. Nils Arne Sörensen
Subject Area
Cardiology, Angiology
Term
since 2023
Project identifier
Deutsche Forschungsgemeinschaft (DFG) - Project number 514575804
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.
DFG Programme
Research Grants
