Proteomic Comparison of Acute Myocardial Infarction and Stress Cardiomyopathy in Women. Homo sapiens

Background: Stress cardiomyopathy (SCM) is a unique form of LV dysfunction that more often occurs in women. Patients with SCM have a higher Troponin I/B-type natriuretic peptide ratio than AMI, but little is known about other circulating proteins. The goals of this study were to compare plasma proteins in SCM and AMI to learn about the pathophysiology of SCM and also to identify putative biomarkers of SCM. Methods: Blood was drawn in normal controls (n=6), women with AMI (n=12) or women with acute SCM (n=15). Two-week follow up samples were available in AMI (n=4) and SCM patients (n=11). Relative concentrations of 1310 serum proteins were measured in each of the 48 samples using the SOMAscan aptamer based assay. Women with AMI tended to be younger (57.87 ± 16.0 vs. 65.08 ± 9.11 years, p=0.12) and had a higher peak troponin I (AMI 32.03 ± 29.46 vs. SCM 2.68 ± 2.6 ng/mL, p=0.02). No differentially expressed proteins were detected (absolute log2 fold change>1; q<0.05) between AMI and SCM in the acute or recovery phase. In the normal vs. AMI comparison there was differential expression of 35 proteins. In the normal vs. SCM comparison there were 45 proteins with differential expression. Pathway analysis demonstrated activation of complement, coagulation, and inflammation in both AMI and SCM. Conclusions: The acute phase of SCM is characterized by a severe inflammatory response similar to AMI. Despite recovery of LV function in SCM at two weeks, differences in circulating proteins remain in comparison to normal controls. Overall design: 48 serum samples total measured. Non fasting venous blood, collected in SST tubes, within 24 hours of hospital admission. Normal controls (n=6), Acute myocardial infarction (AMI) (n=12), acute stress cardiomyopathy (SCM)(n=15), Follow up AMI (n=4), Follow up SCM (n=11)

背景：应激性心肌病（stress cardiomyopathy, SCM）是一类独特的左心室（left ventricle, LV）功能障碍性疾病，更常见于女性人群。应激性心肌病患者的肌钙蛋白I（Troponin I）/B型利钠肽（B-type natriuretic peptide）比值高于急性心肌梗死（acute myocardial infarction, AMI）患者，但目前对其他循环蛋白的了解仍十分有限。本研究旨在对比应激性心肌病与急性心肌梗死患者的血浆蛋白谱，以阐明应激性心肌病的病理生理机制，并筛选出潜在的应激性心肌病生物标志物。
方法：本研究共纳入6名正常对照者、12名急性心肌梗死女性患者以及15名急性应激性心肌病女性患者，采集其静脉血样；另有4名急性心肌梗死患者与11名急性应激性心肌病患者的2周随访血样可供检测，共计48份血清样本。采用基于SOMAscan适配体的检测技术，对48份样本中1310种血清蛋白的相对浓度进行了定量分析。急性心肌梗死女性患者的平均年龄较急性应激性心肌病患者更轻（57.87±16.0 vs. 65.08±9.11岁，p=0.12），且峰值肌钙蛋白I水平更高（急性心肌梗死组32.03±29.46 ng/mL vs. 应激性心肌病组2.68±2.6 ng/mL，p=0.02）。在急性期或恢复期，急性心肌梗死与应激性心肌病患者之间未检测到绝对log2倍数变化>1且校正后q值<0.05的差异表达蛋白。正常对照与急性心肌梗死组对比发现，共有35种蛋白存在差异表达；正常对照与应激性心肌病组对比则发现45种差异表达蛋白。通路分析显示，急性心肌梗死与应激性心肌病患者均存在补体系统、凝血系统以及炎症通路的激活。
结论：应激性心肌病的急性期以与急性心肌梗死相似的重度炎症反应为特征。尽管应激性心肌病患者的左心室功能可在2周时恢复，但与正常对照相比，其循环蛋白谱仍存在显著差异。
整体实验设计：本研究共检测48份血清样本。所有血样均为入院24小时内采集的非空腹静脉血，采集于血清分离胶（Serum Separator Tube, SST）管。样本分组如下：正常对照（n=6）、急性心肌梗死组（n=12）、急性应激性心肌病组（n=15）、急性心肌梗死随访组（n=4）以及应激性心肌病随访组（n=11）