INSERM, Centre d'Investigation Clinique CIC-P 9501, Nancy, France.
Circ Heart Fail. 2013 Nov;6(6):1199-205. doi: 10.1161/CIRCHEARTFAILURE.113.000403. Epub 2013 Aug 27.
Extracellular matrix turnover plays a key role in wound repair after myocardial infarction (MI). The aim of the study was to evaluate whether biomarkers of myocardial fibrosis measurements 1 month after MI may predict left ventricular (LV) remodeling.
This prospective multicenter study included 246 patients with a first anterior Q-wave MI. Echocardiographic studies were performed at hospital discharge and 12 months after MI. Brain natriuretic peptide as well as biomarkers of myocardial fibrosis (type 1 collagen telopeptide, aminoterminal propeptide of type I procollagen, aminoterminal propeptide of type III procollagen) were measured 1 month after MI in 218 patients. In multivariate analysis, aminoterminal propeptide of type III procollagen/type 1 collagen telopeptide ratio ≤1 (odds ratio [95% confidence interval], 1.86 [1.02-3.39]; P=0.043) 1 month after MI and brain natriuretic peptide >100 pg/mL (2.35 [1.28-4.31]; P=0.006) were associated with a pejorative LV remodeling, whereas LV ejection fraction at discharge (per 5% increment; 0.78 [0.65-0.94]; P=0.01) was independently associated with lower rates of detrimental LV remodeling at 12 months. Patients with high brain natriuretic peptide and aminoterminal propeptide of type III procollagen/type 1 collagen telopeptide ratio ≤1, measured 1 month after MI, had the highest risk of developing a primary composite event (cardiovascular death or hospitalization for worsening heart failure; 14 events per 216 patients; P=0.0001) during a 3-year follow-up.
Myocardial fibrosis turnover after MI is associated with LV remodeling. Low aminoterminal propeptide of type III procollagen/type 1 collagen telopeptide ratio (≤1) at 1 month is predictive, in addition to brain natriuretic peptide and LV ejection fraction, of detrimental LV remodeling as well as cardiovascular deaths and hospitalizations for heart failure.
细胞外基质的代谢在心肌梗死后的伤口修复中起着关键作用。本研究的目的是评估心肌纤维化标志物在心肌梗死后 1 个月时的测量是否可以预测左心室重构。
这项前瞻性多中心研究纳入了 246 例首次前壁 Q 波心肌梗死患者。在心肌梗死后出院时和 12 个月时进行超声心动图研究。在 218 例患者中，于心肌梗死后 1 个月时测量脑钠肽以及心肌纤维化的生物标志物（Ⅰ型胶原氨基端肽、Ⅰ型前胶原氨基端肽、Ⅲ型前胶原氨基端肽）。多变量分析显示，心肌梗死后 1 个月时Ⅲ型前胶原氨基端肽/Ⅰ型胶原氨基端肽比值≤1（比值比[95%置信区间]，1.86[1.02-3.39]；P=0.043）和脑钠肽>100pg/mL（2.35[1.28-4.31]；P=0.006）与不良的左心室重构相关，而出院时的左心室射血分数（每增加 5%，0.78[0.65-0.94]；P=0.01）与 12 个月时不良左心室重构的发生率较低独立相关。在心肌梗死后 1 个月时测量高脑钠肽和Ⅲ型前胶原氨基端肽/Ⅰ型胶原氨基端肽比值≤1的患者，在 3 年随访期间发生主要复合终点（心血管死亡或因心力衰竭恶化而住院；216 例患者中有 14 例发生事件；P=0.0001）的风险最高。
心肌梗死后心肌纤维化的代谢与左心室重构有关。在心肌梗死后 1 个月时，Ⅲ型前胶原氨基端肽/Ⅰ型胶原氨基端肽比值（≤1）低，除了脑钠肽和左心室射血分数外，还可以预测不良的左心室重构以及心血管死亡和心力衰竭住院。
