The CASABLANCA Study: Catheter Sampled Blood Archive in Cardiovascular Diseases

The purpose of this research is to determine the relationship between (novel) cardiac and
renal biomarkers before and after angiography. Clearly, having data immediately forewarning
the clinician that cardiomyocyte injury has occurred, or that impending renal failure is
ahead would allow for therapeutic intervention to reduce the likelihood for severe
complications, and would ultimately pave the way for opportunities to derive methods to
better prevent these complications. With the rapid evolution of organ-specific markers of
injury comes an opportunity to explore new venues for their application.

With respect to myocardial injury, a new highly sensitive troponin molecule testing assays
have recently been validated which enables to detect extremely small concentrations of
troponin released in the circulation. With these assays, it may be possible to detect
possible troponin release as early as minutes after injury has occurred.

Accordingly, as a primary goal of the CASABLANCA study, we will examine the release of high
sensitivity troponin assays during catheterization and correlate with clinical and standard
biochemical measures in order to see if a gradient of change during catheterization would be
associated with subsequent recognition of peri-procedural myocardial infarction; it is the
expectation that ultra high-sensitivity troponin methods will allow for nearly immediate
recognition of complications following heart catheterization, when compared to the standard,
non-high sensitivity methods currently in use.

With regards to peri-procedural renal injury, at present, several serum markers are being
studied as potential markers or predictors in contrast induced nephropathy (CIN): Neutrophil
gelatinase-associated lipocalin (NGAL) is highly accumulated in the kidney cortical tubules
and leaks into the circulation after nephrotoxic and ischemic injuries. Up-regulation of
the neutrophil adhesion receptor CD11b has also been associated with acute renal injury
after cardiac surgery, while carbamylated hemoglobin performed quite well in differentiating
acute kidney injury from elevated creatinine due to chronic kidney disease. Finally,
Cystatin-C has shown to have a good accuracy for the early diagnosis of acute kidney injury
before the clinical diagnosis as well.

In addition, blood will be stored for future testing of novel and experimental biomarkers in
'bench-to-bedside' collaborations, as a final yet crucial step in translational research.