World-first Australian test could predict CAD prognosis

Patients with the highest levels of the ACE2 enzyme are at highest risk

In a world first, researchers have shown that measuring a particular enzyme in plasma could predict the risk of events in patients with severe coronary artery disease (CAD).

An Austin Health and University of Melbourne study found patients with obstructive CAD who had the highest levels of the ACE2 enzyme were more than twice as likely to experience a major adverse cardiac event.

ACE2 circulates in low quantities in healthy people but its presence has long been associated with cardiovascular risk such as heart failure, atrial fibrillation, and diabetes.

The researchers tested ACE2 levels in 79 patients with CAD, of whom 46% later experienced CV death, hospitalisation for heart failure or MI.

The median plasma ACE2 activity was 29.3pmol/mL/min and those with higher levels had 2.5 times the risk of an event.

The results suggest that ACE2 might be a useful biomarker for poor prognosis and possibly a target for therapeutic intervention, the authors said, although they conceded their study had a small sample size.

Lead author Professor Louise Burrell from the University of Melbourne is now working on an expanded trial.

“This new blood test helped identify patients who may derive benefit from more aggressive treatment,” she said.

“Future studies are planned to investigate if intensification of the medical treatment in those patients will reduce the risk of death.

"If this were the case, the ACE2 blood test could be offered to all patients with coronary artery disease as part of their risk assessment.”

Read the full study here