Matsuoka Satoshi, Uematsu Manabu, Nakamura Takamitsu, Shimizu Takuya, Futamata Mika, Obata Jun-Ei, Fujioka Daisuke, Nakamura Kazuto, Yoshizaki Toru, Kugiyama Kiyotaka
Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
J Cardiol. 2017 Jan;69(1):320-325. doi: 10.1016/j.jjcc.2016.06.011. Epub 2016 Aug 3.
We recently showed that stromal cell-derived factor (SDF)-1α, a pro-inflammatory mediator, is produced in infarcted myocardium and is associated with left ventricular (LV) adverse remodeling and progressive dysfunction following acute myocardial infarction (AMI). The current study examined whether SDF-1α levels in the peripheral vein can provide prognostic information of outcomes in stable patients with a history of MI.
Plasma levels of SDF-1α in the peripheral vein were measured by enzyme-linked immunosorbent assay in 192 stable patients with a history of MI. All patients were followed prospectively for a period of 90 months or until occurrence of one of the following cardiac events: cardiac death, non-fatal myocardial infarction, unstable angina requiring unplanned coronary revascularization, or worsening heart failure requiring hospital admission.
During the follow-up period (77±26 months), 30 patients had cardiac events. Multivariate Cox analysis revealed that high levels of SDF-1α (≥2162pg/mL; a cut-off value determined by receiver-operating characteristic analysis) were a significant predictor of cardiac events, independent of traditional risk factors (HR: 1.98; 95% CI: 1.38-2.85; p<0.001). The addition of high levels of SDF-1α to conventional risk factors including brain natriuretic peptide improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.90, p<0.0001; and IDI 0.05, p=0.002).
High levels of SDF-1α predicted secondary cardiac events in stable patients with a history of MI. SDF-1α levels may be a useful risk assessment tool in patients with a history of MI.
我们最近发现，促炎介质基质细胞衍生因子（SDF）-1α 在梗死心肌中产生，并且与急性心肌梗死（AMI）后左心室（LV）不良重构和进行性功能障碍相关。本研究旨在探讨外周静脉中 SDF-1α 水平是否可为有心肌梗死病史的稳定患者的预后提供信息。
采用酶联免疫吸附测定法测量 192 例有心肌梗死病史的稳定患者外周静脉血浆中 SDF-1α 的水平。所有患者均进行前瞻性随访，为期 90 个月，或直至发生以下心脏事件之一：心源性死亡、非致命性心肌梗死、需要进行非计划性冠状动脉血运重建的不稳定型心绞痛或需要住院治疗的心力衰竭恶化。
在随访期间（77±26 个月），30 例患者发生心脏事件。多变量 Cox 分析显示，高水平的 SDF-1α（≥2162pg/mL；通过受试者工作特征分析确定的临界值）是心脏事件的重要预测指标，独立于传统危险因素（HR：1.98；95%CI：1.38-2.85；p<0.001）。将高水平的 SDF-1α 添加到包括脑钠肽在内的传统危险因素中，可改善净重新分类改善（NRI）和综合判别改善（IDI）（NRI 0.90，p<0.0001；IDI 0.05，p=0.002）。
高水平的 SDF-1α 可预测有心肌梗死病史的稳定患者发生继发性心脏事件。SDF-1α 水平可能是有心肌梗死病史患者有用的风险评估工具。
