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.
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。