Kelly Dominic, Cockerill Gillian, Ng Leong L, Thompson Matt, Khan Sohail, Samani Nilesh J, Squire Iain B
Department of Vascular Surgery, St George's Hospital Medical School, London, UK.
Eur Heart J. 2007 Mar;28(6):711-8. doi: 10.1093/eurheartj/ehm003. Epub 2007 Mar 5.
To describe temporal profiles of plasma matrix metalloproteinases (MMP-2 and MMP-9), and their relationship with echocardiographic (Echo) parameters of left ventricular (LV) function and remodelling, after acute myocardial infarction (AMI) in man.
Plasma MMP-2 and MMP-9 were assayed at intervals (0-12, 12-24, 24-48, 48-72, 72-96, and > 96 h) in 91 patients with AMI (ST-elevation/non-ST-elevation 77/24; 73% male; 40% anterior site) and on a single occasion in 172 age- and sex-matched control subjects with stable coronary artery disease. Echo assessment of LV volumes, LV ejection fraction (LVEF), and wall motion index score were assessed before discharge and at follow-up (median 176, range 138-262 days) for patients and on a single occassion in controls. Plasma MMP-2 was similar at all times after AMI, elevated when compared with control (P = 0.005-0.001) and unrelated to LV function or volume during index admission or at follow-up. Maximal MMP-9 was seen at 0-12 h and was elevated when compared with control (P = 0.002) followed by fall to a plateau. Both maximal and plateau MMP-9 concentration correlated with white blood cell (WBC, P = 0.023 to < 0.001) and neutrophil count (P = 0.014 to < 0.001). Maximal MMP-9 had independent predictive value for lower LVEF (P = 0.004) during admission and for greater change in LV end-diastolic volume between admission and follow-up (R = 0.3, P = 0.016). In contrast, higher plateau levels of MMP-9 were associated with relative preservation of LV function (increasing LVEF, P = 0.002; decreasing WMIS, P = 0.009) and less change in end-systolic volume and end-diastolic volumes after discharge (P = 0.001 and 0.024, respectively).
Both MMP-9 and MMP-2 are elevated following AMI. The biphasic profile of plasma MMP-9 is related to LV remodelling and function following AMI in man. Higher early levels of MMP-9 associate with the extent of LV remodelling and circulating WBC levels. In contrast, higher plateau levels later after AMI are associated with relative preservation of LV function. Temporal profile, rather than absolute magnitude, of MMP-9 activity appears to be important for LV remodelling after AMI.
描述急性心肌梗死（AMI）后人体血浆基质金属蛋白酶（MMP - 2和MMP - 9）的时间变化情况，及其与左心室（LV）功能和重构的超声心动图（Echo）参数之间的关系。
对91例AMI患者（ST段抬高型/非ST段抬高型77/24；男性73%；前壁部位40%）在不同时间间隔（0 - 12、12 - 24、24 - 48、48 - 72、72 - 96及>96小时）测定血浆MMP - 2和MMP - 9，并对172例年龄和性别匹配的稳定型冠心病对照者进行单次测定。对患者在出院前及随访（中位数176天，范围138 - 262天）时进行左心室容积、左心室射血分数（LVEF）及室壁运动指数评分的超声心动图评估，对对照者进行单次评估。AMI后各时间点血浆MMP - 2水平相似，与对照组相比升高（P = 0.005 - 0.001），且在入院时或随访期间与左心室功能或容积无关。MMP - 9在0 - 12小时达到峰值，与对照组相比升高（P = 0.002），随后降至平台期。MMP - 9的峰值和平台期浓度均与白细胞（WBC，P = 0.023至<0.001）及中性粒细胞计数（P = 0.014至<0.001）相关。MMP - 9峰值对入院时较低的LVEF（P = 0.004）及入院与随访期间左心室舒张末期容积的较大变化具有独立预测价值（R = 0.3，P = 0.016）。相反，较高的MMP - 9平台期水平与左心室功能的相对保留相关（LVEF增加，P = 0.002；室壁运动指数评分降低，P = 0.009），且出院后收缩末期容积和舒张末期容积变化较小（分别为P = 0.001和0.024）。
AMI后MMP - 9和MMP - 2均升高。血浆MMP - 9的双相变化情况与人AMI后的左心室重构及功能相关。早期较高的MMP - 9水平与左心室重构程度及循环白细胞水平相关。相反，AMI后较晚出现的较高平台期水平与左心室功能的相对保留相关。MMP - 9活性的时间变化情况而非绝对水平似乎对AMI后的左心室重构很重要。
