Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients

Matthew J. Lawrence; Ahmed Sabra; Phillip Thomas; Daniel R. Obaid; Lindsay A. D'Silva; Roger H.K. Morris; Karl Hawkins; Martin R. Brown; Phylip R. Williams; Simon J. Davidson; Alexander J. Chase; David Smith; Phillip A. Evans

doi:10.1016/j.atherosclerosis.2015.04.012

Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients

Matthew J. Lawrence, Ahmed Sabra, Phillip Thomas, Daniel R. Obaid, Lindsay A. D'Silva, Roger H.K. Morris, Karl Hawkins, Martin R. Brown, Phylip R. Williams, Simon J. Davidson, Alexander J. Chase, David Smith, Phillip A. Evans^*

^*Corresponding author for this work

Cardiff School of Sport and Health Sciences

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Objectives: Changes in clot microstructure are increasingly implicated in the pathology of atherosclerosis although most data are from techniques in the remote laboratory using altered blood. We validate the novel biomarker Gel Point in STEMI patients and assess therapeutic interventions. Gel Point marks the transition of blood from a visco-elastic liquid to visco-elastic solid and is rapidly measured using unadulterated blood. The Gel Point provides measurements of three parameters to reflect clot microstructure (fractal dimension (d_f)), real-time clot formation time (T_GP) and blood clot strength (elasticity at the Gel Point (G'_GP)). Methods: We prospectively recruited 38 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Venous blood samples were collected on admission, after pPCI and 24h after admission for assessment of the new biomarkers, standard coagulation tests and scanning electron microscopy (SEM). Results: d_f after pPCI was lower than d_f on admission (mean 1.631 [SD 0.063] vs 1.751 [0.052], p<0.000001) whereas d_f at 24h was similar to that on admission. G'_GP also showed similar trend to d_f (p<0.001). T_GP was prolonged at after-PCI measurement compared with admission (median 854s [IQR 581-1801] vs 217 [179-305], p<0.00001). Changes in the values of d_f and G'_GP were consistent with changes in the SEM images of the mature clot. Conclusions: We characterise Gel Point derived markers of clot microstructure in patients admitted with emergency arterial thrombosis. This point of care test can potentially be used to assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.

Original language	English
Pages (from-to)	402-407
Number of pages	6
Journal	Atherosclerosis
Volume	240
Issue number	2
DOIs	https://doi.org/10.1016/j.atherosclerosis.2015.04.012
Publication status	Published - 13 Apr 2015

Keywords

Acute myocardial infarction
Coagulation
Drug monitoring
Fractal dimension
Gel point
Percutaneous coronary intervention

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10.1016/j.atherosclerosis.2015.04.012

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Lawrence, M. J., Sabra, A., Thomas, P., Obaid, D. R., D'Silva, L. A., Morris, R. H. K., Hawkins, K., Brown, M. R., Williams, P. R., Davidson, S. J., Chase, A. J., Smith, D., & Evans, P. A. (2015). Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients. Atherosclerosis, 240(2), 402-407. https://doi.org/10.1016/j.atherosclerosis.2015.04.012

@article{787a121fc98944b2a5de90fdf7f2dbc2,

title = "Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients",

abstract = "Objectives: Changes in clot microstructure are increasingly implicated in the pathology of atherosclerosis although most data are from techniques in the remote laboratory using altered blood. We validate the novel biomarker Gel Point in STEMI patients and assess therapeutic interventions. Gel Point marks the transition of blood from a visco-elastic liquid to visco-elastic solid and is rapidly measured using unadulterated blood. The Gel Point provides measurements of three parameters to reflect clot microstructure (fractal dimension (df)), real-time clot formation time (TGP) and blood clot strength (elasticity at the Gel Point (G'GP)). Methods: We prospectively recruited 38 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Venous blood samples were collected on admission, after pPCI and 24h after admission for assessment of the new biomarkers, standard coagulation tests and scanning electron microscopy (SEM). Results: df after pPCI was lower than df on admission (mean 1.631 [SD 0.063] vs 1.751 [0.052], p<0.000001) whereas df at 24h was similar to that on admission. G'GP also showed similar trend to df (p<0.001). TGP was prolonged at after-PCI measurement compared with admission (median 854s [IQR 581-1801] vs 217 [179-305], p<0.00001). Changes in the values of df and G'GP were consistent with changes in the SEM images of the mature clot. Conclusions: We characterise Gel Point derived markers of clot microstructure in patients admitted with emergency arterial thrombosis. This point of care test can potentially be used to assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.",

keywords = "Acute myocardial infarction, Coagulation, Drug monitoring, Fractal dimension, Gel point, Percutaneous coronary intervention",

author = "Lawrence, {Matthew J.} and Ahmed Sabra and Phillip Thomas and Obaid, {Daniel R.} and D'Silva, {Lindsay A.} and Morris, {Roger H.K.} and Karl Hawkins and Brown, {Martin R.} and Williams, {Phylip R.} and Davidson, {Simon J.} and Chase, {Alexander J.} and David Smith and Evans, {Phillip A.}",

note = "Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd.",

year = "2015",

month = apr,

day = "13",

doi = "10.1016/j.atherosclerosis.2015.04.012",

language = "English",

volume = "240",

pages = "402--407",

journal = "Atherosclerosis",

issn = "0021-9150",

number = "2",

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Lawrence, MJ, Sabra, A, Thomas, P, Obaid, DR, D'Silva, LA, Morris, RHK, Hawkins, K, Brown, MR, Williams, PR, Davidson, SJ, Chase, AJ, Smith, D & Evans, PA 2015, 'Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients', Atherosclerosis, vol. 240, no. 2, pp. 402-407. https://doi.org/10.1016/j.atherosclerosis.2015.04.012

TY - JOUR

T1 - Fractal dimension

T2 - A novel clot microstructure biomarker use in ST elevation myocardial infarction patients

AU - Lawrence, Matthew J.

AU - Sabra, Ahmed

AU - Thomas, Phillip

AU - Obaid, Daniel R.

AU - D'Silva, Lindsay A.

AU - Morris, Roger H.K.

AU - Hawkins, Karl

AU - Brown, Martin R.

AU - Williams, Phylip R.

AU - Davidson, Simon J.

AU - Chase, Alexander J.

AU - Smith, David

AU - Evans, Phillip A.

PY - 2015/4/13

Y1 - 2015/4/13

N2 - Objectives: Changes in clot microstructure are increasingly implicated in the pathology of atherosclerosis although most data are from techniques in the remote laboratory using altered blood. We validate the novel biomarker Gel Point in STEMI patients and assess therapeutic interventions. Gel Point marks the transition of blood from a visco-elastic liquid to visco-elastic solid and is rapidly measured using unadulterated blood. The Gel Point provides measurements of three parameters to reflect clot microstructure (fractal dimension (df)), real-time clot formation time (TGP) and blood clot strength (elasticity at the Gel Point (G'GP)). Methods: We prospectively recruited 38 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Venous blood samples were collected on admission, after pPCI and 24h after admission for assessment of the new biomarkers, standard coagulation tests and scanning electron microscopy (SEM). Results: df after pPCI was lower than df on admission (mean 1.631 [SD 0.063] vs 1.751 [0.052], p<0.000001) whereas df at 24h was similar to that on admission. G'GP also showed similar trend to df (p<0.001). TGP was prolonged at after-PCI measurement compared with admission (median 854s [IQR 581-1801] vs 217 [179-305], p<0.00001). Changes in the values of df and G'GP were consistent with changes in the SEM images of the mature clot. Conclusions: We characterise Gel Point derived markers of clot microstructure in patients admitted with emergency arterial thrombosis. This point of care test can potentially be used to assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.

AB - Objectives: Changes in clot microstructure are increasingly implicated in the pathology of atherosclerosis although most data are from techniques in the remote laboratory using altered blood. We validate the novel biomarker Gel Point in STEMI patients and assess therapeutic interventions. Gel Point marks the transition of blood from a visco-elastic liquid to visco-elastic solid and is rapidly measured using unadulterated blood. The Gel Point provides measurements of three parameters to reflect clot microstructure (fractal dimension (df)), real-time clot formation time (TGP) and blood clot strength (elasticity at the Gel Point (G'GP)). Methods: We prospectively recruited 38 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Venous blood samples were collected on admission, after pPCI and 24h after admission for assessment of the new biomarkers, standard coagulation tests and scanning electron microscopy (SEM). Results: df after pPCI was lower than df on admission (mean 1.631 [SD 0.063] vs 1.751 [0.052], p<0.000001) whereas df at 24h was similar to that on admission. G'GP also showed similar trend to df (p<0.001). TGP was prolonged at after-PCI measurement compared with admission (median 854s [IQR 581-1801] vs 217 [179-305], p<0.00001). Changes in the values of df and G'GP were consistent with changes in the SEM images of the mature clot. Conclusions: We characterise Gel Point derived markers of clot microstructure in patients admitted with emergency arterial thrombosis. This point of care test can potentially be used to assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.

KW - Acute myocardial infarction

KW - Coagulation

KW - Drug monitoring

KW - Fractal dimension

KW - Gel point

KW - Percutaneous coronary intervention

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U2 - 10.1016/j.atherosclerosis.2015.04.012

DO - 10.1016/j.atherosclerosis.2015.04.012

M3 - Article

C2 - 25890059

AN - SCOPUS:84927725579

SN - 0021-9150

VL - 240

SP - 402

EP - 407

JO - Atherosclerosis

JF - Atherosclerosis

IS - 2

ER -

Fractal dimension: A novel clot microstructure biomarker use in ST elevation myocardial infarction patients

Abstract

Keywords

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