An experimental blood test suggests that it’s possible to give a person up to two weeks' notice that they are at serious risk for suffering a heart attack, says a new study led by renowned Scripps Health cardiologist Eric Topol.
If the test turns out to be reliable, it could enable doctors to intervene with at-risk patients and possibly prevent many heart attacks and the damage they cause.
The findings are based on a study of 50 people who reported to four San Diego County hospitals while they were having a heart attack. A blood test revealed that circulating endothelial cells, or CECs, that normally coat the inside of heart arteries were sloughing off, allowing a blood clot to develop in patients. That’s a classic cause of a heart attack.
“The CECs are supposed to be like insulation for the artery,” said Topol, chief academic officer at Scripps Health. “When they start to slough off, become numerous, misshapen and have multiple nuclei, it is sign that a heart attack is imminent. They’re a biomarker.”
The findings were reported today in the journal Science Translational Medicine.
Physicians are eager to develop better ways to determine if a person is suffering heart-related problems before any damage to the heart occurs. Heart disease is the leading cause of death in the U.S., killing almost 600,000 people a year.
Currently, it’s not unusual for a patient to report to an emergency room with chest pains. If blood tests show that they haven’t suffered damage, they’re often sent home. Some suffer heart attacks within a matter of days.
Topol and his colleagues say that a heart attack takes shape days and weeks before it actually happens. The chain reaction can begin with CEC’s flaking off the interior wall of one of the three main arteries on the surface of the heart. That causes the artery to crack and results in a blood clot.
“It is the clot that cuts off the blood supply and serves as the proximate cause of a heart attack,” Topol said. “Eventually, a plaque ruptures and a blood clot develops.”
The new test might represent a more direct way for ER physicians to determine if a heart attack is imminent.
Scientists have long suspected that CECs can become trouble makers when they become sickly. But their true impact only became obvious as advances in technology made it possible for researchers to more clearly see and analyze the cells. The newest version of the blood test genetically confirms the presence of sick CECs.
Topol recently began evaluating this simpler, faster, more powerful version of the blood test on a group that will number 200 people. The plan is to test people at the time they show up at ERs complaining of chest pain.
If the research continues to go well, the test might be approved for use in hospitals within a couple of years.
He has been working on the study with his colleagues at the Scripps Translational Science Institute, a collaboration between Scripps Health and The Scripps Research Institute.
The earlier study also involved scientists and doctors from Veridex LLC, Palomar Health and Sharp HealthCare. The study was underwritten by a $2 million grant from the National Institutes of Health.
“This is a small study and the findings would need to replicated in a large clinical population before this becomes available for clinical practice,” said Shaista Malik, director of the Preventive Cardiology Program at UC Irvine.
“However, that said, this is very exciting and innovative study. The ability to predict who might have a heart attack would result in many lives being saved. Approximately one-third of people who suffer heart attacks die before even reaching the hospital. Even among those who reach the hospital, early diagnosis would result in improved treatment.
“With a heart attack, time to diagnosis and treatment is critical. The faster the blocked artery that is causing the heart attack is opened up, the less damage there is to the heart muscle. With this type of test that can tell early on, possibly even before symptoms set in, would really change clinical practice and improve the prognosis for someone suffering a heart attack.”Copyright © 2017, The San Diego Union-Tribune