Metabolic technologies allow the profiling of low-molecular weight biochemicals such as amino acids, sugars, and lipids that are substrates and products in important biological processes, such as ischaemia.  To examine whether this techology could be used to allow earlier detection of myocardial ischaemia and infarction, Lewis et al. applied mass spectrometry-based metabolite profiling to 36 patients undergoing alcohol septal ablation for hypertrophic cardiomyopathy.

Blood samples were collected before and at various intervals after the procedure, and coronary sinus sampling was used to distinguish cardiac-derived from peripheral metabolites.  Alterations in the levels of multiple metabolites were detected as early as 10 minutes after infarction, even in patients who had no rise in contemporary bimarkers (e.g. troponin) at 12 hours.  Furthermore, the same pattern of metabolites was not seen in a control group of nine patients undergoing elective cardiac catheterisation.

Multiple biomarker assays such as this are likely to play a major role in the future detection of cardiac damage, providing early warning of impending ischaemic damage and facilitating early intervention.  However, it is too early to consider mainstream use of such assays; the fundamental next step will be examining the metabolic profiles of patients undergoing genuine acute coronary syndromes.

• Lewis GD, Wei R, Liu E, et al. Metabolite profiling of blood from individuals undergoing planned myocardial infarction reveals early markers of myocardial injury. J Clin Invest 2008:DOI: 10.1172/JCI35111.