Ulgen Mehmet S, Ozturk Onder, Alan Sait, Kayrak Mehmet, Turan Yasar, Tekes Selehattin, Toprak Nizamettin
Meram medical School, Department of Cardiology, Selcuk University, Konya, Turkey.
Coron Artery Dis. 2007 May;18(3):153-7. doi: 10.1097/MCA.0b013e328010a4c4.
The development of left ventricular remodeling after acute myocardial infarction is a predictor of heart failure and mortality. The genetic influence on cardiac remodeling in the early period after acute myocardial infarction, is however, unclear. The aim ofthis study was to investigate the relationship between angiotensin-converting enzyme (ACE) gene polymorphism and left ventricular remodeling in the early period in patients with anterior myocardial infarction.
The study population consisted of 142 patients with their first attack of acute anterior myocardial infarction. Echocardiographic examinations were performed within 24 h of the first attack (first evaluation) and on the fifth day of acute myocardial infarction (second evaluation). Left ventricular end systolic and diastolic diameters, left ventricular end systolic and diastolic volumes, ejection fraction, mitral flow velocities (E, A, E/A), deceleration time, isovolumic relaxation time and myocardial performance index were calculated. ACE I/D polymorphism was determined using polymerase chain reaction amplification.
On the basis of polymorphism of the ACE gene, the patients were classified into the three groups: group 1, deletion/deletion (n=59) genotype, group 2 insertion/deletion (n=69), and group 3 insertion/insertion (n=14) genotype. When the first and second sets of echocardiographic results of the groups were compared, all parameters were not different among three groups. In group analysis, Left ventricular systolic diameters, left ventricular diastolic diameters, left ventricular end diastolic diameters, left ventricular ejection fraction and myocardial performance index between first and second echocardiographic results were significantly different in deletion/deletion group and only myocardial performance index and left ventricular ejection fraction in insertion/deletion group (P<0.05).
ACE gene polymorphism may influence early cardiac remodeling after acute myocardial infarction. Patients with the deletion/deletion-insertion/deletion genotype may be particularly more sensitive to ACE-I treatment possibly owing to the more prominent role of the renin-angiotensin system.
急性心肌梗死后左心室重构的发展是心力衰竭和死亡率的一个预测指标。然而，急性心肌梗死后早期基因对心脏重构的影响尚不清楚。本研究的目的是探讨血管紧张素转换酶（ACE）基因多态性与前壁心肌梗死患者早期左心室重构之间的关系。
研究人群包括142例首次发作急性前壁心肌梗死的患者。在首次发作后24小时内（首次评估）和急性心肌梗死后第5天（第二次评估）进行超声心动图检查。计算左心室收缩末期和舒张末期直径、左心室收缩末期和舒张末期容积、射血分数、二尖瓣血流速度（E、A、E/A）、减速时间、等容舒张时间和心肌性能指数。采用聚合酶链反应扩增法测定ACE I/D多态性。
根据ACE基因多态性，将患者分为三组：第1组，缺失/缺失（n = 59）基因型；第2组，插入/缺失（n = 69）；第3组，插入/插入（n = 14）基因型。比较三组的第一组和第二组超声心动图结果时，三组之间所有参数均无差异。在组间分析中，缺失/缺失组首次和第二次超声心动图结果之间的左心室收缩直径、左心室舒张直径、左心室舒张末期直径、左心室射血分数和心肌性能指数有显著差异，插入/缺失组仅心肌性能指数和左心室射血分数有显著差异（P<0.05）。
ACE基因多态性可能影响急性心肌梗死后的早期心脏重构。缺失/缺失-插入/缺失基因型的患者可能对ACE-I治疗特别敏感，这可能是由于肾素-血管紧张素系统的作用更为突出。
