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Abstract：
BACKGROUND: Biomarkers simplifying the diagnostic workup by discriminating between non-ST-segment-elevation myocardial infarction (NSTEMI) and infarct-like myocarditis are an unmet clinical need.
RESULTS: A total of 105 subjects were categorized into groups as follows: ST-segment-elevation myocardial infarction (n=36), NSTEMI (n=22), infarct-like myocarditis (n=19), cardiomyopathy-like myocarditis (n=18), and healthy control (n=10). All subjects underwent cardiac magnetic resonance imaging, and serum concentrations of matrix metalloproteinase-1 (MMP-1) and procollagen type I carboxy terminal propeptide (PICP) were measured. Biomarker concentrations in subjects presenting with acute coronary syndrome and non-ST-segment-elevation, for example NSTEMI or infarct-like myocarditis, categorized as the non-ST-segment-elevation acute coronary syndrome-like cohort, were of particular interest for this study. Compared with healthy controls, subjects with myocarditis had higher serum concentrations of MMP-1 and PICP, while no difference was observed in individuals with myocardial infarction. In the non-ST-segment-elevation acute coronary syndrome-like cohort, MMP-1 concentrations discriminated infarct-like myocarditis and NSTEMI with an area under the receiver operating characteristic curve (AUC) of 0.95 (95% CI, 0.89-1.00), whereas high-sensitivity cardiac troponin T performed inferiorly (AUC, 0.74 [95% CI, 0.58-0.90]; P=0.012). Application of an optimal MMP-1 cutoff had 94.4% sensitivity (95% CI, 72.7%-99.9%) and 90.9% specificity (95% CI, 70.8%-98.9%) for the diagnosis of infarct-like myocarditis in this cohort. The AUC of PICP in this context was 0.82 (95% CI, 0.68-0.97). As assessed by likelihood ratio tests, incorporating MMP-1 or PICP with age and C-reactive protein into composite prediction models enhanced their diagnostic performance.
CONCLUSIONS: MMP-1 and PICP could potentially be useful biomarkers for differentiating between NSTEMI and infarct-like myocarditis in individuals with non-ST-segment-elevation acute coronary syndrome-like presentation, though further research is needed to validate their clinical applicability.
RESULTS: A total of 105 subjects were categorized into groups as follows: ST-segment-elevation myocardial infarction (n=36), NSTEMI (n=22), infarct-like myocarditis (n=19), cardiomyopathy-like myocarditis (n=18), and healthy control (n=10). All subjects underwent cardiac magnetic resonance imaging, and serum concentrations of matrix metalloproteinase-1 (MMP-1) and procollagen type I carboxy terminal propeptide (PICP) were measured. Biomarker concentrations in subjects presenting with acute coronary syndrome and non-ST-segment-elevation, for example NSTEMI or infarct-like myocarditis, categorized as the non-ST-segment-elevation acute coronary syndrome-like cohort, were of particular interest for this study. Compared with healthy controls, subjects with myocarditis had higher serum concentrations of MMP-1 and PICP, while no difference was observed in individuals with myocardial infarction. In the non-ST-segment-elevation acute coronary syndrome-like cohort, MMP-1 concentrations discriminated infarct-like myocarditis and NSTEMI with an area under the receiver operating characteristic curve (AUC) of 0.95 (95% CI, 0.89-1.00), whereas high-sensitivity cardiac troponin T performed inferiorly (AUC, 0.74 [95% CI, 0.58-0.90]; P=0.012). Application of an optimal MMP-1 cutoff had 94.4% sensitivity (95% CI, 72.7%-99.9%) and 90.9% specificity (95% CI, 70.8%-98.9%) for the diagnosis of infarct-like myocarditis in this cohort. The AUC of PICP in this context was 0.82 (95% CI, 0.68-0.97). As assessed by likelihood ratio tests, incorporating MMP-1 or PICP with age and C-reactive protein into composite prediction models enhanced their diagnostic performance.
CONCLUSIONS: MMP-1 and PICP could potentially be useful biomarkers for differentiating between NSTEMI and infarct-like myocarditis in individuals with non-ST-segment-elevation acute coronary syndrome-like presentation, though further research is needed to validate their clinical applicability.
摘要：
背景：通过区分非ST段抬高型心肌梗死（NSTEMI）和梗死样心肌炎来简化诊断检查的生物标志物是尚未满足的临床需求。
结果：共有105名受试者分为以下几组：ST段抬高型心肌梗死（n=36），NSTEMI（n=22），梗死样心肌炎(n=19),心肌病样心肌炎（n=18），和健康控制（n=10）。所有受试者都接受了心脏磁共振成像，测定血清基质金属蛋白酶-1（MMP-1）和I型前胶原羧基末端前肽（PICP）的浓度。急性冠脉综合征和非ST段抬高患者的生物标志物浓度,例如NSTEMI或梗塞样心肌炎，归类为非ST段抬高型急性冠脉综合征样队列，对这项研究特别感兴趣。与健康对照相比，心肌炎患者的血清MMP-1和PICP浓度较高，而在心肌梗死患者中没有观察到差异。在非ST段抬高型急性冠脉综合征样队列中,MMP-1浓度区分梗死样心肌炎和NSTEMI，受试者工作特征曲线下面积（AUC）为0.95（95％CI，0.89-1.00），而高敏心肌肌钙蛋白T表现不佳(AUC，0.74[95%CI，0.58-0.90]；P=0.012）。在该队列中，最佳MMP-1截止值的应用对梗死样心肌炎的诊断具有94.4％的敏感性（95％CI，72.7％-99.9％）和90.9％的特异性（95％CI，70.8％-98.9％）。在这种情况下,PICP的AUC为0.82(95%CI,0.68-0.97)。通过似然比检验评估，将MMP-1或PICP与年龄和C反应蛋白纳入复合预测模型可增强其诊断性能.
结论：MMP-1和PICP可能是区分非ST段抬高急性冠脉综合征样表现的NSTEMI和梗死样心肌炎的有用生物标志物，尽管需要进一步的研究来验证其临床适用性。
结果：共有105名受试者分为以下几组：ST段抬高型心肌梗死（n=36），NSTEMI（n=22），梗死样心肌炎(n=19),心肌病样心肌炎（n=18），和健康控制（n=10）。所有受试者都接受了心脏磁共振成像，测定血清基质金属蛋白酶-1（MMP-1）和I型前胶原羧基末端前肽（PICP）的浓度。急性冠脉综合征和非ST段抬高患者的生物标志物浓度,例如NSTEMI或梗塞样心肌炎，归类为非ST段抬高型急性冠脉综合征样队列，对这项研究特别感兴趣。与健康对照相比，心肌炎患者的血清MMP-1和PICP浓度较高，而在心肌梗死患者中没有观察到差异。在非ST段抬高型急性冠脉综合征样队列中,MMP-1浓度区分梗死样心肌炎和NSTEMI，受试者工作特征曲线下面积（AUC）为0.95（95％CI，0.89-1.00），而高敏心肌肌钙蛋白T表现不佳(AUC，0.74[95%CI，0.58-0.90]；P=0.012）。在该队列中，最佳MMP-1截止值的应用对梗死样心肌炎的诊断具有94.4％的敏感性（95％CI，72.7％-99.9％）和90.9％的特异性（95％CI，70.8％-98.9％）。在这种情况下,PICP的AUC为0.82(95%CI,0.68-0.97)。通过似然比检验评估，将MMP-1或PICP与年龄和C反应蛋白纳入复合预测模型可增强其诊断性能.
结论：MMP-1和PICP可能是区分非ST段抬高急性冠脉综合征样表现的NSTEMI和梗死样心肌炎的有用生物标志物，尽管需要进一步的研究来验证其临床适用性。
