Cardiology Department, Faculty Hospital Brno, Jihlavska 20, Brno 625 00, Czech Republic.
BMC Cardiovasc Disord. 2010 Dec 17;10:60. doi: 10.1186/1471-2261-10-60.
We evaluated the associations among angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism, ACE activity and post-myocardial infarction (MI) left ventricular dysfunction and acute heart failure (AHF) early after presentation with MI with ST-segment elevation (STEMI).
A total of 556 patients with STEMI treated by primary PCI (421 patients without AHF and 135 patients with AHF) were the study population. The activity of BNP, NT-ProBNP and ACE were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI.
In comparison with the II genotypes group, the DD/ID group had a higher level of ACE activity upon hospital admission (p < 0.001). We found a significantly higher level of ACE activity in patients with moderate LV dysfunction (EF 40-54%) in comparison both with patients with preserved LV function (EF ≥ 55%) and with patients with severe LV dysfunction (p = 0.028). A non-significant trend towards a higher incidence of mild AHF (22.1% vs. 16.02%, p = 0,093), a significantly higher value of end-systolic volume (ESV/BSA) (30.0 ± 12.3 vs. 28.5 ± 13.0; p < 0.05) and lower EF (50.2 ± 11.1 vs. 52.7 ± 11.7; p < 0.05) in the DD/ID genotypes group was noted. Even after multiple adjustments according to multivariate models, the EF for the DD/ID group remained significantly lower (p = 0,033). The DD/ID genotypes were associated with a significantly higher risk of EF <45% (OR 2.04 [95% CI 1.28; 3.25]).
These results suggest that the I/D polymorphism of ACE is associated with the development of LV dysfunction in the acute phase after STEMI. We demonstrated for the first time an association of the low ACE activity with the severe LV dysfunction, although patients with moderate LV dysfunction had higher level ACE activity than patients with preserved LV function.
我们评估了血管紧张素转换酶（ACE）基因插入/缺失（I/D）多态性、ACE 活性与心肌梗死后左心室功能障碍和急性心力衰竭（AHF）之间的关系，以及这些关系与 ST 段抬高型心肌梗死（STEMI）患者入院时和发病后 24 小时的关系。
共纳入 556 例行直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者（421 例无 AHF，135 例 AHF）。入院时和心肌梗死后 24 小时测定 BNP、NT-ProBNP 和 ACE 活性。在 PCI 前进行左心室造影，在心肌梗死后第 3 至 5 天进行超声心动图检查。
与 II 基因型组相比，DD/ID 组入院时 ACE 活性更高（p<0.001）。与保留左心室功能（EF≥55%）和严重左心室功能障碍（p=0.028）患者相比，中重度左心室功能障碍（EF 40-54%）患者的 ACE 活性显著更高。轻度 AHF 的发生率有升高趋势（22.1%比 16.02%，p=0.093），但差异无统计学意义。DD/ID 基因型组的左心室收缩末期容积（ESV/BSA）（30.0±12.3 比 28.5±13.0；p<0.05）和左心室射血分数（EF）（50.2±11.1 比 52.7±11.7；p<0.05）均显著更低。即使根据多变量模型进行多次调整后，DD/ID 基因型组的 EF 仍显著更低（p=0.033）。DD/ID 基因型与 EF<45%的风险显著升高相关（OR 2.04[95%CI 1.28-3.25]）。
这些结果表明，ACE 的 I/D 多态性与 STEMI 后急性期左心室功能障碍的发生有关。我们首次证明，低 ACE 活性与严重左心室功能障碍相关，尽管中度左心室功能障碍患者的 ACE 活性高于保留左心室功能患者。
