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Quicker Blood Test Means Quicker Treatment

When cardiologist Mike Fifer happened to mention to his colleague Rob Gerszten that he was admitting a patient to Mass General’s coronary care unit for a planned heart attack, "a light went off for both of us," Gerszten recalls.

They realized it was the perfect opportunity to search for new blood markers of heart attack. Heart attacks change levels of chemicals in the blood, but current tests look for changes that take hours to happen. Gerszten and Fifer wanted to find chemical changes that occur immediately.

This is most important because all of our treatments for heart injury work best very early after the injury has started," Gerszten says.

Needing a Heart Attack

The researchers and their team studied patients with a rare condition called hypertrophic cardiomyopathy.

"In this unique situation, patients actually have too much heart muscle," explains Gerszten. "We perform a planned heart attack to minimize the excess heart muscle, and only in this unique scenario after the heart attack do the patients actually improve."

The team was able to take blood samples before, during and after the planned heart attacks. Collaborating with the Broad Institute of MIT and Harvard, where Gerszten is an senior associate member, they used a technique called high performance liquid chromatography-mass spectrometry (HPLC-MS) to identify and compare the levels of hundreds of different chemicals in the blood samples.

"Within 10 minutes of a heart attack we found approximately 10 new changes in the blood that had previously never been described," Gerszten says.

But since this group of patients each served as their own "control group," the researchers needed to find out if their findings would generalize to the rest of us if we have an unplanned heart attack.

So, as they wrote in the Journal of Clinical Investigation, the team then studied blood samples of heart attack patients coming into the emergency room to see if they would show the same chemical signature.

"And indeed, these changes that we saw in a planned heart attack were also seen in patients having spontaneous heart attacks as well," says Gerszten.
"This is early proof of principle that these tools will work," he adds. "Obviously, we need to test them in large groups of subjects now– not just tens or hundreds of subjects, but in thousands of subjects coming into the emergency department to see if they hold up in these larger studies."

Win-Win Situation

It’s also possible that the research may lead to better treatments. "I think that these changes that we found in the blood also have important implications for our therapy for heart attacks as well," Gerszten says. "We clearly see abnormal changes in certain biochemical pathways in the heart. That suggests targets for therapeutic intervention."

He hopes in a few years this early detection will lead to widespread treatment of heart attacks, not in hours, but in minutes.

"We’re very excited that we’ve identified new chemical changes in the blood that indicate the earliest changes after a heart attack," he says. "But the subjects have also benefited from this procedure, so it’s really a win-win situation."

This research was published in the Journal of Clinical Investigation, online publication October 2008, and was funded by: NIH, the Donald W. Reynolds Foundation, Fondation Leducq, Heart Failure Society of America, American Heart Association, the Harvard/MIT Clinical Investigator Training Program, the Broad Institute Scientific Planning Allocation of Resources Committee, the Sarnoff Cardiovascular Research Foundation and the Keck Foundation.

Elsewhere on the Web:

"Metabolomics: What’s Happening Downstream of DNA" from Environmental Health Perspectives

American Heart Association

National Heart, Lung & Blood Institute

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   April 3rd, 2009 at 2:52 am (#)

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