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Originally published March 21, 2012 at 5:14 PM | Page modified March 21, 2012 at 5:58 PM

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Doctors discover a clue in quest to predict heart attack

Although physicians can easily detect a heart attack that has started, every year tens of thousands of patients pass a stress test, only to have a serious heart attack within weeks.

Los Angeles Times

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LOS ANGELES — Doctors are a step closer to a simple test that could predict whether a patient is about to have a heart attack by using a blood sample to detect cells that have sloughed off damaged blood-vessel walls.

The finding, published Wednesday in the journal Science Translational Medicine, could potentially address "the greatest unmet need" facing cardiologists, said lead author Dr. Eric Topol, a cardiologist at the Scripps Translational Science Institute in San Diego.

Although physicians can easily detect a heart attack that has started, every year tens of thousands of patients pass a stress test, only to have a serious heart attack within weeks.

Topol called the phenomenon the "Tim Russert syndrome," referring to the newsman who died of a heart attack in 2008, weeks after undergoing a stress test, with apparently normal results.

""We'd like to prevent the heart attack from happening," or mitigate its effects with drugs, Topol said.

The new technique involves tracking a type of cell in the blood called a circulating endothelial cell.

Endothelial cells create a wrapper that lines the inside of blood vessels. When the vessel is damaged, endothelial cells break away and enter the bloodstream.

Healthy people have very few of these circulating cells. But a person with mild cholesterol buildup can develop a crack in an artery wall that disrupts the lining and sends them into the blood.

A heart attack occurs when an area of plaque ruptures in an artery, forming a blood clot that blocks blood flow to the heart, resulting in heart-tissue damage.

Ruptures resulting from mild cholesterol buildups can lead to particularly deadly heart attacks, said Dr. Douglas Zipes, a cardiologist at the Indiana University School of Medicine in Indianapolis, because patients with such blockages are often asymptomatic, and — unlike people with larger blockages — are unlikely to have developed new blood vessels that can help bypass the obstruction.

Knowing the endothelial lining has been damaged before a blood clot grows might allow physicians to predict onset of a heart attack or stroke, said Zipes, who was not involved in the study.

Dr. Robert Harrington, a professor of medicine at Duke University, lauded that the research is helping scientists understand the biology of heart attacks.

But he cautioned that more study was needed to flesh out and confirm the results and to prepare a test for patients. The methods presented in the Scripps research may be too complicated for use in a doctor's office or an emergency room, he said.

One key question is how long before a heart attack the circulating endothelial cells appear. "Is it a day before? A week before? That would be good to understand," he said.

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