Diagnostic Implications of Elevated Levels of Smooth-Muscle Myosin Heavy-Chain Protein in Acute Aortic Dissection: The Smooth Muscle Myosin Heavy Chain Study

  1. Toru Suzuki, MD;
  2. Hirohisa Katoh, PhD;
  3. Yasuhiro Tsuchio, MD;
  4. Akira Hasegawa, MD;
  5. Masahiko Kurabayashi, MD;
  6. Atsushi Ohira, MD;
  7. Katsuhiko Hiramori, MD;
  8. Yasunari Sakomura, MD;
  9. Hiroshi Kasanuki, MD;
  10. Shingo Hori, MD;
  11. Naoki Aikawa, MD;
  12. Satoshi Abe, MD;
  13. Chuwa Tei, MD;
  14. Yoshihisa Nakagawa, MD;
  15. Masakiyo Nobuyoshi, MD;
  16. Kazuhiko Misu, MD;
  17. Tetsuya Sumiyoshi, MD; and
  18. Ryozo Nagai, MD
  1. From University of Tokyo, Tokyo Women's Medical University, Keio University, and Sakakibara Heart Institute, Tokyo; Gunma University, Gunma; Iwate Medical University, Iwate; Kagoshima University, Kagoshima; and Kokura Memorial Hospital, Kokurakita-ku, Japan.

    Abstract

    Background: A rapid 30-minute assay of circulating smooth-muscle myosin heavy-chain protein has been developed as a biochemical diagnostic tool for aortic dissection.

    Objective: To determine the sensitivity and specificity of this assay.

    Design: Cross-sectional study.

    Setting: 8 major cardiovascular centers in Japan.

    Patients: 95 patients with acute aortic dissection, 48 patients with acute myocardial infarction, and 131 healthy volunteers.

    Measurements: Levels of circulating smooth-muscle myosin heavy-chain protein.

    Results: Patients with acute aortic dissection who presented within 3 hours after onset had elevated levels of circulating smooth-muscle myosin heavy-chain protein. In these patients, the assay had a sensitivity of 90.9%, a specificity of 98% compared with healthy volunteers, and a specificity of 83% compared with patients who had acute myocardial infarction; the clinical decision limit was 2.5 µg/L. All patients with proximal lesions had elevated levels of smooth-muscle myosin heavy-chain protein, and only patients with distal lesions had decreased levels (<2.5 µg/L).

    Conclusions: Levels of smooth-muscle myosin heavy-chain protein can be used to diagnose aortic dissection soon after symptom onset. The assay had the greatest diagnostic value in patients with proximal lesions.

    Article and Author Information

    • Acknowledgments: The authors thank the diagnostics division of Yamasa Corp. for assistance in performing the assays.

    • Requests for Single Reprints: Toru Suzuki, MD, Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; e-mail, torusuzu-tky{at}umin.ac.jp.

    • Current Author Addresses: Drs. Suzuki, Katoh, and Nagai: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

    • Drs. Tsuchio, Hasegawa and Kurabayashi: Second Department of Internal Medicine, School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8511, Japan.

    • Drs. Ohira and Hiramori: Second Department of Internal Medicine, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka-shi, Iwate 020-8505, Japan.

    • Drs. Sakomura and Kasanuki: Cardiology Department, Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

    • Drs. Hori and Aikawa: Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan.

    • Drs. Abe and Tei: First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8520, Japan.

    • Drs. Nakagawa and Nobuyoshi: Department of Cardiology, Kokura Memorial Hospital, 1-1 Kifune-machi, Kokurakita-ku, Kitakyushu 802-8555, Japan.

    • Drs. Misu and Sumiyoshi: Department of Cardiology, Sakakibara Heart Institute, 2-5-4 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan.

    • Author Contributions: Conception and design: T. Suzuki, H. Katoh, R. Nagai.

    • Analysis and interpretation of the data: T. Suzuki, H. Katoh, R. Nagai.

    • Drafting of the article: T. Suzuki, H. Katoh, R. Nagai.

    • Critical revision of the article for important intellectual content: T. Suzuki, H. Katoh, R. Nagai.

    • Final approval of the article: T. Suzuki, H. Katoh, R. Nagai, Y. Tsuchio, A. Hasegawa, M. Kurabayashi, A. Ohira, K. Hiramori, Y. Sakomura, H. Kasanuki, S. Hori, N. Aikawa, S. Abe, C. Tei, Y. Nakagawa, M. Nobuyoshi, K. Misu, T. Sumiyoshi.

    • Provision of study materials or patients: T. Suzuki, H. Katoh, R. Nagai, Y. Tsuchio, A. Hasegawa, M. Kurabayashi, A. Ohira, K. Hiramori, Y. Sakomura, H. Kasanuki, S. Hori, N. Aikawa, S. Abe, C. Tei, Y. Nakagawa, M. Nobuyoshi, K. Misu, T. Sumiyoshi.

    • Statistical expertise: T. Suzuki, H. Katoh, R. Nagai.

    • Obtaining of funding: T. Suzuki, H. Katoh, R. Nagai.

    • Administrative, technical, or logistic support: T. Suzuki, H. Katoh, R. Nagai.

    • Collection and assembly of data: T. Suzuki, H. Katoh, R. Nagai, Y. Tsuchio, M. Kurabayashi, A. Ohira, K. Hiramori, Y. Sakomura, H. Kasanuki, S. Hori, N. Aikawa, S. Abe, C. Tei, Y. Nakagawa, M. Nobuyoshi, K. Misu, T. Sumiyoshi.

    Summary for Patients

    • Summaries for Patients:Biochemical Test To Help Diagnose Aortic Dissection Ann Intern Med October 3, 2000 133:I-50
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    1. Ann Intern Med October 3, 2000 vol. 133 no. 7 537-541
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