Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain.
Atherosclerosis. 2010 Aug;211(2):574-8. doi: 10.1016/j.atherosclerosis.2010.04.017. Epub 2010 Apr 21.
Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in patients with ST-segment elevation myocardial infarction (STEMI).
We prospectively assessed 108 STEMI patients (age 64 + or - 11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96 + or - 10h after the onset of symptoms and 12 month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12 months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI.
At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45 + or - 1.04 vs 5.19 + or - 1.39 nmol/L; p<0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928-4.990, p<0.001] to [3.32, CI 95% 1.999-5.532, p<0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84-0.96, p<0.0001) compared to 0.579 for BNP (CI 95% 0.409-0.748) regarding LVR.
In STEMI patients undergoing primary PCI, high neopterin levels - but not BNP - predict LVR at 1-year follow-up.
左心室重构（LVR）是急性心肌梗死后较为常见且不利的事件。炎症与 LVR 之间存在关联。新蝶呤是炎症和巨噬细胞活化的标志物，是冠状动脉疾病患者左心室功能障碍的预测因子。因此，我们试图评估在 ST 段抬高型心肌梗死（STEMI）患者中，新蝶呤和脑钠肽（BNP）——左心室功能障碍和患者预后的标志物——是否与 LVR 相关。
我们前瞻性评估了 108 例接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者（年龄 64 ± 11 岁；85%为男性），在症状发作后 96 ± 10 小时和 STEMI 后 12 个月进行了超声心动图评估。左心室重构定义为与基线相比，12 个月随访时 LV 舒张末期容积增加>20%。在直接 PCI 前立即测量新蝶呤和 BNP 血清浓度。
在 1 年时，21 例（19%）患者出现 LVR，87 例（81%）患者无 LVR。LVR 患者的新蝶呤水平在研究开始时更高（7.45 ± 1.04 与 5.19 ± 1.39 nmol/L；p<0.001）。在调整相关混杂因素后，新蝶呤水平是 LVR 的独立预测因子（比值比范围为[3.10，95%CI 1.928-4.990，p<0.001]至[3.32，95%CI 1.999-5.532，p<0.001]）。ROC 分析显示，新蝶呤的曲线下面积为 0.901（95%CI 0.84-0.96，p<0.0001），而 BNP 的曲线下面积为 0.579（95%CI 0.409-0.748），两者均与 LVR 相关。
在接受直接 PCI 的 STEMI 患者中，高新蝶呤水平——而不是 BNP——可预测 1 年随访时的 LVR。
