Sweat Analysis as Prognosticator After Heart Attack
Condition: Acute Myocardial Infarction
MeSH terms: Myocardial Infarction; Infarction
Study type: Observational [Patient Registry]

Summary: 
      This study characterizes non-invasive body inflammation response in sweat and blood of
      patients suffering from acute myocardial infarction and explores the potential of
      non-invasive sweat analysis a an innovative approach for predicting patient outcome.
    

Detailed description: 
      Background:

      Different risk scores exist for predicting patient outcome after acute coronary syndrome and
      percutaneous coronary intervention (PCI). This is of importance to optimize post
      interventional patient management as well as treatment and to reduce the risks of
      re-hospitalization and mortality. ST-elevation myocardial infarction (STEMI) has been
      associated with an instant upregulation of the sympathetic nervous system leading to
      adrenergic stimulation and immune system activation in different organs such as the heart and
      skin. In skin, sympathetic fibers travel together, appear as single nerve fibers in the
      dermis as well as in the epidermis, and activate inflammation by norepinephrine secretion.
      Further, STEMI has been associated with increased sweating during the acute phase. In an
      unpublished pilot trial, we detected a broad panel of inflammation markers in sweat (such as
      MCP-1, TGFβ, uPa, TRAIL) of healthy volunteers. Sweat immunologic marker analysis is an
      interesting and novel approach for assessment of sympathetic activation and inflammation.

      Objective and methods:

      Our primary objective is to assess a non-invasive body inflammation response in sweat and
      blood of patients suffering from STEMI after PCI (+4h) and at outpatient follow up (±4-6
      weeks). Body inflammation marker concentrations in sweat and blood will be set into context
      to cardiovascular risk factors, GRACE and TIMI STEMI scores, door-to-balloon time, length of
      hospital stay , left ventricular ejection fraction, peak troponin-I, and NT-proBNP
      concentrations to investigate the STEMI/PCI - sympathetic nervous system - inflammation axis.
      A total of 18 subjects with STEMI and 6 patients undergoing diagnostic coronary angiography
      without PCI will be recruited in a clinical, single-center pilot study at Örebro University
      Hospital. Sweat will be collected using the CE certified Macroduct Collecting System and
      blood samples will be taken. Analysis will be performed with Olink proteomic analysis.

      Clinical relevance:

      STEMI and subsequent reperfusion are associated with an increase in inflammatory response.
      Myocardial reperfusion injury contributes significant to myocardial injury after STEMI.
      Adequate patient monitoring and therapy after PCI is essential to preserve cardiac function,
      prevent re-hospitalization, heart failure and death.

      Prospects:

      Biomarkers can be collected by smart biosensors and may provide novel longitudinal insights
      into health and disease. On-skin sweat analysis using wearable devices are increasingly
      available and will allow collection of non-invasive and patient-centered molecular health
      information in the future. This may help to investigate a better understanding of sympathetic
      nervous system upregulation after STEMI/PCI.
    

Intervention name(s): Examination and analysis of sweat and blood samples at baseline and at follow up; Examination and analysis of sweat and blood samples at baseline
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): Subjects will be assessed at baseline (as inpatients) and at 4-6 weeks at follow-up as outpatients according to standard operating procedures. Sweat samples will be collected using the CE certified Macroduct Sweat Collector and inflammatory parameters measured. Venous blood will be drawn and inflammatory parameters, Troponin-I and nt-proBNP measured. Further examinations include measurement of left ventricular ejection fraction by echocardiography at baseline and blood pressure, heart rate, risk scores and health information will be collected at baseline and follow up.; Sweat samples will be collected using the CE certified Macroduct Sweat Collector and inflammatory parameters measured. Venous blood will be drawn and inflammatory parameters, Troponin-I and nt-proBNP measured. Blood pressure, heart rate, risk scores and health information will collected.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Study participants will be recruited among patients referred to Örebro University Hospital
        a tertiary teaching hospital and regional acute care hospital.
      
Biospecimen description: 
      Sweat and venous blood samples for analysis and storage in a biobank in Örebro for potential
      future analysis.
    
Keywords: Sweat analysis; Myocardial reperfusion injury; Personalized patient monitoring; Acute myocardial infarction; Upregulated sympathetic nervous system; Inflammation