Kelly D, Khan S, Cockerill G, Ng L L, Thompson M, Samani N J, Squire I B
Department of Cardiovascular Sciences, University of Leicester, UK.
Eur J Heart Fail. 2008 Feb;10(2):133-9. doi: 10.1016/j.ejheart.2007.12.009. Epub 2008 Jan 30.
Changes to cardiac matrix are central to ventricular remodelling after acute MI and matrix metalloproteinase expression is implicated in this process. We investigated the temporal profile of MMP-3 and its relationship to LV dysfunction and prognosis following AMI.
We studied 382 patients with AMI. Plasma MMP-3 was measured at 0-12, 12-24 h and for subsequent 24 h periods during admission. LV function (LVEF) was assessed by echocardiography pre-discharge and at a median of 148 days and clinical endpoints at a median of 313 days.
MMP-3 peaked prior to discharge thus pre-discharge levels were used in analyses. MMP-3 was associated with patient age (p<0.001), creatinine (p<0.001) and was higher in males (p<0.001) and hypertensives (p<0.001). MMP-3 inversely correlated with LVEF at follow-up (p=0.043), was higher in subjects with LVEF <40% (p=0.017) and in subjects with increasing EDV (p=0.017) or ESV (p=0.007) compared to those in whom volumes fell between visits. In the 58 patients reaching the endpoint of death or heart failure, MMP-3 was higher (p<0.001). On Kaplan-Meier analysis, subjects with levels above optimum cut off identified via ROC curves were more likely to suffer a clinical event (p=0.037).
MMP-3 is associated with left ventricular dysfunction, adverse left ventricular remodelling and prognosis after AMI.
急性心肌梗死后心脏基质的变化是心室重构的核心，基质金属蛋白酶的表达参与了这一过程。我们研究了基质金属蛋白酶-3（MMP-3）的时间变化情况及其与急性心肌梗死后左心室功能障碍和预后的关系。
我们研究了382例急性心肌梗死患者。入院期间在0 - 12小时、12 - 24小时以及随后的24小时时间段测量血浆MMP-3。出院前、中位数为148天时通过超声心动图评估左心室功能（左心室射血分数），中位数为313天时评估临床终点。
MMP-3在出院前达到峰值，因此分析中使用出院前水平。MMP-3与患者年龄（p<0.001）、肌酐（p<0.001）相关，在男性（p<0.001）和高血压患者（p<0.001）中更高。随访时MMP-3与左心室射血分数呈负相关（p = 0.043），与左心室射血分数<40%的患者相比更高（p = 0.017），与随访期间左心室舒张末期容积（EDV）增加（p = 0.017）或左心室收缩末期容积（ESV）增加（p = 0.007）的患者相比更高，而与那些容积下降的患者相比。在58例达到死亡或心力衰竭终点的患者中，MMP-3更高（p<0.001）。根据Kaplan-Meier分析，通过ROC曲线确定的高于最佳临界值水平的患者更有可能发生临床事件（p = 0.037）。
MMP-3与急性心肌梗死后左心室功能障碍、不良左心室重构和预后相关。
