Losing Regulation of the Extracellular Matrix is Strongly Predictive of Unfavorable Prognostic Outcome after Acute Myocardial Infarction

This study tested the hypothesis that MMP-9−/−tPA−/− double knock out (i.e., MTDKO) plays a crucial role in the prognostic outcome after acute myocardial infarction (AMI by ligation of left-coronary-artery) in MTDKO mouse. Animals were categorized into sham-operated controls in MTDKO animals (group 1) and in wild type (B6: group 2), AMI-MTDKO (group 3) and AMI-B6 (group 4) animals. They were euthanized, and the ischemic myocardium was harvested, by day 60 post AMI. The mortality rate was significantly higher in group 3 than in other groups and significantly higher in group 4 than in groups 1/2, but it showed no difference in the latter two groups (all p < 0.01). By day 28, the left-ventricular (LV) ejection fraction displayed an opposite pattern, whereas by day 60, the gross anatomic infarct size displayed an identical pattern of mortality among the four groups (all p < 0.001). The ratio of heart weight to tibial length and the lung injury score exhibited an identical pattern of mortality (p < 0.01). The protein expressions of apoptosis (mitochondrial-Bax/cleaved-caspase3/cleaved-PARP), fibrosis (Smad3/T-GF-ß), oxidative stress (NOX-1/NOX-2/oxidized-protein), inflammation (MMPs2,9/TNF-α/p-NF-κB), heart failure/pressure overload (BNP/ß-MHC) and mitochondrial/DNA damage (cytosolic-cytochrome-C/γ-H2AX) biomarkers displayed identical patterns, whereas the angiogenesis markers (small vessel number/CD31+cells in LV myocardium) displayed opposite patterns of mortality among the groups (all p < 0.0001). The microscopic findings of fibrotic/collagen deposition/infarct areas and inflammatory cell infiltration of LV myocardium were similar to the mortality among the four groups (all p < 0.0001). MTDKO strongly predicted unfavorable prognostic outcome after AMI.

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Effect of early hypolipidemic therapy of different intensity on endothelial function in patients with acute myocardial infarction with ST segment elevation

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2019.6.2738 ◽

2020 ◽

Vol 26 (6) ◽

pp. 27-38

Author(s):

O. M. Parkhomenko ◽

A. O. Stepura ◽

Y. M. Lutay ◽

O. I. Irkin ◽

D. O. Bilyi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Endothelial Function ◽

High Intensity ◽

Ldl Cholesterol ◽

Lipid Lowering ◽

St Segment Elevation ◽

Group 4 ◽

St Segment ◽

Group 3

The aim – to evaluate the effect of different hypolipidemic therapy on changes in endothelial function in patients with acute myocardial infarction with ST segment elevation (STEMI).Materials and methods. The study enrolled 135 patients with STEMI within the 12 hours of symptoms onset (average 4.7±1.0) who were admitted to the intensive care unit at NSC «M.D. Strazhesko Institute of Cardiology». Patients were distributed into 4 groups by envelope method. At the enrolment to the hospital patients were prescribed hypolipidemic therapy till the procedure of revascularization – percutaneous coronary intervention. The first (1st) group included 26 pts who were prescribed a combination of atorvastatin (10 mg) and ezetimibe (10 mg). The second (2nd) group included 24 pts, who were prescribed atorvastatin at a dose of 40 mg. The third (3rd) group included 43 pts, who received 80 mg of atorvastatin, the fourth (4th) group included 42 pts who were prescribed a combination of atorvastatin 40 mg and ezetimibe 10 mg. Basic therapy was formed according to the current guidelines of the European Society of Cardiologists and the National Diagnostic Protocols. The selected groups did not have difference in clinical and anamnestic characteristics and methods of treatment. Determination of reactive hyperemia using flow-dependent vasodilatation (FDV) was performed on the 1st and 10th days of the hospital period and within the 90th day of onset of the disease onset. Results and discussion. Prescription of high-intensity lipid-lowering therapy using 80 mg of atorvastatin (group 3) and 40 mg of atorvastatin and 10 mg of ezetimibe (group 4) caused a greater lipid-lowering effect compared to the medium-intensity therapy (group 1 and 2) in the dynamics of observation. Group 3 patients experienced a significant decrease in low-density lipoprotein cholesterol (LDL cholesterol) on the 10th and 90th days, and its decrease reached values below the recommended values (up to 1.75±0.11 mmol/L. In group 4 on we recorded a significant decrease in LDL cholesterol on the 10th day and by the 90th day it was 1.55 mmol/L. The mean LDL cholesterol level below the target was only reached in groups 3 and 4. Normalization of endothelial function (FDV greater than 10 %) was significantly more frequently observed in patients who reached less than 1.8 mmol/L by the 90th day of target LDL cholesterol. Conclusions. For the normalization of endothelial function (increase in FDV) during hypolipidemic therapy in patients undergoing STEMI, it is necessary to achieve the target values of LDL cholesterol up to 90 days of the disease, which is possible only when conducting high-intensity hypolipidemic therapy. The absence of improvement in endothelial function during observation in a constant number of patients suggests that there may be additional, possibly genetic, factors that are not affected by the treatments used.

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Abstract 4206: Microvascular Dysfunction and Left Ventricular Chamber Stiffness after Successful Percutaneous Coronary Intervention Critically Determine Left Ventricular Remodeling in Patients with Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_843-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Atsushi Yamamuro ◽

Takashi Akasaka ◽

Shuichiro Kaji ◽

Koichi Tamita ◽

Minako Katayama ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Microvascular Dysfunction ◽

Coronary Intervention ◽

Left Ventricular ◽

Percutaneous Coronary ◽

Lv Remodeling ◽

Group 3 ◽

Group 1 ◽

Deceleration Time

In patients with acute myocardial infarction (AMI), the short deceleration time of left ventricular (LV) early filling by Doppler is a powerful independent predictor of LV remodeling. On the other hand, recent studies have shown that microvascular dysfunction in recanalized infarct-related coronary arteries may predict progressive LV dilation. The purpose of this study was to examine the effects of both microvascular dysfunction and LV chamber stiffness on LV remodeling after successful percutaneous coronary intervention (PCI) in AMI patients. Two hundred and one consecutive patients with first anterior AMI were studied following successful PCI. Microvascular injury was evaluated on the basis of coronary flow velocity patterns immediately after successful PCI using Doppler guidewires. We defined the presence of microvascular dysfunction as diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. LV filling patterns were determined by mitral inflow pulsed-wave Doppler examination on day 3 after AMI. Deceleration time ≤130 ms was defined as restrictive. We classified the patients into three categories: without restrictive and microvascular dysfunction (group 1, n=116), with restrictive or microvascular dysfunction (group 2, n= 38), and with restrictive and microvascular dysfunction (group 3, n=47). Left ventriculograms were obtained immediately and 6 months after PCI. LV remodeling was defined as an increase in end-diastolic volume index ≥20%. Group 3 was at the highest risk of LV remodeling, while group 1 was at the lowest (Table ). Assessment of both microvascular dysfunction and LV chamber stiffness enable accurate prediction of LV remodeling in AMI patients after successful PCI. LV remodeling in each group

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Features of Changes in the Structural and Functional State of the Myocardium in Patients with Acute Myocardial Infarction Depending on Body Mass Index Considering FABP4 and CTRP3 Levels

Galician Medical Journal ◽

10.21802/gmj.2021.3.7 ◽

2021 ◽

Vol 28 (3) ◽

pp. E202137

Author(s):

Mariia Koteliukh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Body Mass Index ◽

Body Mass ◽

Statistical Significance ◽

Left Ventricular ◽

Normal Body Mass Index ◽

Echocardiographic Parameters ◽

Group 3 ◽

Group 2

Introduction. Adipokines such as fatty acid-binding protein 4 (FABP4) and C1q tumor necrosis factor-related protein 3 (CTRP3) can affect the structural and functional state of the myocardium in patients with acute myocardial infarction and obesity. The objective of the research was to determine the relationship between FABP4, CTRP3 and echocardiographic parameters of the left ventricular myocardium in patients with acute myocardial infarction depending on body mass index. Materials and Methods. The observational cross-sectional study examined 189 patients with acute myocardial infarction depending on body mass index, who were divided into the following groups: Group 1 included 60 patients with acute myocardial infarction and normal body mass index; Group 2 comprised 68 patients with acute myocardial infarction and excess body weight; Group 3 included 61 patients with acute myocardial infarction and obesity. Results. In Group 1, the statistical significance correlations were found: between FABP4 and end-diastolic dimension (EDD; r = -0.458), end-systolic dimension (ESD; r = -0.460), end-diastolic volume (EDV; r = -0.452), left ventricular myocardial mass (LVMM; r = -0.411), LVMM/body surface area index (LVMMI2; r = -0.419); between CTRP3 and EDV (r = 0.425), EDD (r = 0.469), left ventricular relative posterior wall thickness (LVRPWT; r = -0.469). In Group 2, there were found the statistical significance relationships between: FABP4 and EDD (r = 0.461), ESD (r = 0.467), EDV (r = 0.449), end-systolic volume (ESV; r = 0.485), LVMM (r = 0.487), LVMMI1 (r = 0.406); between CTRP3 and EDD (r = -0.440), EDV (r = -0.413), LVMM (r = -0.430), LVMM/height2.7 index (LVMMI1; r = -0.483). In Group 3, the statistical significance correlations were found between: FABP4 and EDV (r = 0.481), ESD (r = 0.411), ESV (r = 0.490), LVMMI1 (r = 0.403); between CTRP3 and EDV (r = -0.326), ESD (r = -0.367), ESV (r = -0.453), LVMMI1 (r = -0.415). Conclusions. In patients with acute myocardial infarction and overweight/obesity, echocardiographic parameters had a significant low positive correlation with FABP4 and a low negative correlation with CTRP3. On the contrary, in patients with acute myocardial infarction and normal body mass index, echocardiographic parameters had a significant low negative correlation with FABP4 and a low positive correlation with CTRP3.

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