Background Mortality derived from ST-elevation myocardial infarction (STEMI) has decreased due to primary percutaneous coronary intervention (PCI). Paradoxically, the incidence of heart failure secondary to left ventricular remodelling (LVR) is on the rise due to the survival derived from reperfusion strategies. The aim of this study was to assess the prognostic value for LVR of biomarkers involved in several pathophysiological mechanisms activated during STEMI treated with primary PCI.
Methods 112 patients with STEMI undergoing primary PCI were evaluated. LVR was defined as a ≥20% increase in the left ventricular end-diastolic volume at 6-month follow-up assessed using echocardiogram as compared with that at discharge. Blood samples were obtained for glucose, N-terminal pro-brain natriuretic peptide, troponin T (TnT), matrix metalloproteinase 9, procollagen type-I N-terminal propeptide and high-sensitivity C reactive protein (hs-CRP).
Results 24 patients (21%) developed LVR. Higher levels of maximum TnT, and matrix metalloproteinase 9 and hs-CRP at discharge, were detected as independent risk factors for LVR (OR 1.310, p=0.03; OR 1001, p=0.04; OR 1.040, p=0.04, respectively). Both TnT and hs-CRP showed significant ability to distinguish patients who developed LVR from those who did not, being the values that yielded the greatest sensitivity and specificity as follows: TnT 7.0 μg/l (73%, 84%), hs-CRP 30 mg/l (59%, 85%).
Conclusions Myocardial necrosis, as measured by released TnT, and inflammation state evident due to circulating levels of CRP are factors that may play a major role in the development of LVR following STEMI treated with primary PCI.
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- left ventricular remodelling
- ST-elevation myocardial infarction
- cardiac remodelling
- cardiomyopathy hypertrophic
- great vessels and trauma
- cardiac function
- heart failure
- myocardial disease
- coagulation factors
- deep vein thrombosis
- platelet activation
- transient ischaemic attack
- congenital heart disease
- tissue doppler
Funding The Echocardiography Laboratory at Virgen del Rocio University Hospital has received a research grant from the Andalusian Society of Cardiology (Seville, Spain) aimed at the development of this project. The Andalusian Society of Cardiology had no involvement in the collection, analysis or interpretation of data, the writing of the report, nor in the decision to submit the paper for publication.
Competing interests None.
Ethics approval Comite de Etica de la Investigacion de Centro, Virgen del Rocio University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
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