Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Circulating MMP-1 and PICP levels discriminate infarct-like myocarditis and non-ST-elevation myocardial infarction
L. Bacmeister1, E. Cavus2, S. Bohnen3, E. Tahir4, T. Zeller2, F. Ojeda2, U. K. Radunski5, G. Lund4, G. Adam4, S. Blankenberg2, D. Westermann1, K. Müllerleile6, D. Lindner1
1Innere Medizin III, Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg im Breisgau; 2Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 3Kardiologie, Asklepios Klinik St. Georg, Hamburg; 4Klinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg; 5Klinik für Kardiologie, Regio Klinikum Elmshorn, Elmshorn; 6Kardiologische Praxis Orchideenstieg, Hamburg;

Background

Non-ST-elevation myocardial infarction (NSTEMI) and infarct-like (IL) myocarditis are common in patients presenting with acute coronary syndrome (ACS). However, these patients share most clinical features, such as chest pain, unspecific findings on electrocardiogram (ECG), elevated cardiac enzymes, and regional wall motion abnormalities on echocardiography. Thus, biomarkers discriminating these entities are an unmet clinical need. 

 
Methods

A guideline directed diagnostic work up including cardiac magnetic resonance imaging (CMR) was performed allocating 105 subjects to either ST-elevation MI (STEMI, n = 36), NSTEMI (n = 22), IL-myocarditis (n = 19), cardiomyopathy-like (CM) myocarditis (n = 18), or healthy control (n = 10). A refined study cohort comprised NSTEMI and IL-myocarditis (NSTE-ACS-like cohort). Matrix metalloproteinase-1 (MMP-1) and Procollagen type I carboxy terminal propeptide (PICP) were measured in all subjects at the time of CMR. Main objective was to assess whether circulating MMP-1 and PICP levels can discriminate between subjects with NSTEMI and IL-myocarditis.

 

Results

Compared with healthy controls, levels of MMP-1 and PlCP were significantly higher in subjects with myocarditis, but not in those with MI. Furthermore, median MMP-1 and PICP levels were higher in IL-myocarditis than in NSTEMI. In the NSTE-ACS-like cohort, MMP-1 discriminated IL-myocarditis and NSTEMI with an area under the receiver operator characteristic (AUC) of 0.95 (Interquartile range [IQR] 0.89, 1.00). A cut-off of > 4.46 ng/ml MMP-1 had 94.4 % (95 % confidence interval [CI] 72.7 %, 99.9 %) sensitivity and 90.9 % (CI 70.8 %, 98.9%) specificity, resulting in a positive predictive value (PPV) of 89.5 % (CI 69.3 %, 97.0 %), and a negative predictive value (NPV) of 95.2 % (CI 74.8 %, 99.3 %) for the diagnosis of IL-myocarditis in the NSTE-ACS-like cohort. Using a cut-off of > 0.039 for the ratio MMP-1/hs-TnT provided a PPV of 93.3 % (CI 67.1 %, 99.0 %), and the combination of MMP-1 and PICP (MMP-1 x PICP > 2251 ng2/ml2) showed a PPV of 94.1 %(CI 70.1 %, 99.1 %). No combination was superior to MMP-1 with regards to NPV.

 

Conclusion

MMP-1 and PICP may be valuable biomarkers for the triage of subjects presenting with non-ST-elevation ACS and elevated cardiac biomarkers in which NSTEMI and IL-myocarditis are clinically suspected.
https://dgk.org/kongress_programme/jt2023/aP528.html