A breakthrough discovery combining two powerful technologies looks set to help doctors intervene earlier and perhaps prevent heart failure in at risk patients, who have already had a heart attack.
The international collaboration between research clinicians at the University of Otago's Christchurch Heart Institute, and the National University of Singapore, combines two kinds of testing in blood and heart cells, resulting in fast identification of new blood markers flagging potential future heart failure.
Professor Mark Richards.
Professor Mark Richards, Consultant Cardiologist and Senior Researcher with the Christchurch Heart Institute, and Deputy Director at the National University Heart Centre Singapore, says the findings will make a significant difference to the prognosis and treatment of heart attack patients who are at risk of heart failure.
The teams' innovative method has involved sifting through massive amounts of data to reveal six new, high priority indicators of heart failure in patients with a heart attack which will be further researched.
It is hoped that the proteins identified, or the pathways within which they operate, may provide predictive or diagnostic tests to be applied after heart attacks to identify those at highest risk of HF allowing targeted surveillance and early intensification of protective treatment.
Secondly, the proteins and their intra-cellular pathways may be therapeutic targets subject to either blockade or augmentation by new drugs or biological treatments that can protect the injured heart from progression to HF.
"Finding the precise biomarkers in the blood that indicate potential for future heart failure after a heart attack is like looking for a 'needle in a haystack'," Professor Richards says.
"First, Associate Professor Mark Chan and his team in Singapore applied plasma proteomics– a term used to describe high-throughput analysis of plasma proteins – using a highly sensitive technique. This made it possible to reliably detect more than a thousand proteins in the blood of each patient, despite some proteins having very low levels."
Minute quantities of proteins were detected, revealing more than 200 marker proteins that predicted the future onset of heart failure up to seven years after a heart attack.
Professor Richards says a second technology discovery was to cross-reference the proteins by analysing single heart cells one-at-a-time, rather than the usual method of cells in bulk.
That meant the researchers were able to detect subtle but important changes in the way the genes encoding the marker proteins (discovered in patients' blood samples by proteomics), were turned on and off in individual cells.
This study, the results of which were published online ahead-of-print in the journal Circulation, involved 200 patients from Singapore and 500 New Zealanders who had experienced a heart attack.
"Strong and reliable signals to identify those patients who may be unfortunate enough to incur heart failure following their heart attack, remains an urgent need," said Professor Richards.
"This work, the result of bilateral and inter-disciplinary collaboration, has taken us an important step closer to being able to step-in post-heart attack and more fully protect patients from further harm."
