Bernelin Hugo, Mewton Nathan, Si-Mohamed Salim, Croisille Pierre, Rioufol Gilles, Bonnefoy-Cudraz Eric, Douek Philippe, Dufay Nathalie, Amaz Camille, Jossan Claire, Ovize Michel, Bochaton Thomas
Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
Service d'explorations fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
Clin Cardiol. 2019 Jan;42(1):32-38. doi: 10.1002/clc.23090. Epub 2018 Dec 10.
Several preliminary analyses suggested an association between neprilysin (NEP) levels and myocardial infarction.
The objective was to assess whether NEP plasma levels following reperfusion might be a surrogate for infarct size (IS) or predict adverse outcomes in acute ST-segment elevation myocardial infarction (STEMI) patients.
We measured NEP levels in a prospective cohort of 203 patients with STEMI referred for primary percutaneous coronary intervention. Circulating soluble NEP was measured by enzyme-linked immunosorbent assay at admission (t0) and 4 hours later (t4) following reperfusion and on 7 times points (t0, t4, t12, t24, t48, day 7 and day 30) in a subset of 21 patients. IS and left ventricular ejection fraction (LVEF) were measured at 1 month by cardiac magnetic resonance. Adverse cardiovascular outcomes were collected at 12-month follow-up.
Median t0 and t4 NEP levels in 203 patients were respectively 88.3 pg/mL (interquartile range [IQR] [14; 375.4]) and 101.5 pg/mL (IQR [18.5; 423.8]). These levels remained unchanged over 1 month (P = 0.70). NEP levels did not correlate significantly with IS (P = 0.51) or LVEF (P = 0.34). There was no correlation between NEP and troponin, creatine kinase and interleukin-6 levels at h0 and h4. NEP levels above the median were not associated with adverse outcomes at follow-up (hazard ratio = 1.28, 95% confidence interval [0.69; 2.37]; P = 0.42).
NEP serum levels were widely distributed and did not change significantly in the first hours and 1-month period following reperfusion in STEMI patients. There was no significant relationship with markers of infarct size and inflammation, and 1-year adverse outcomes.
多项初步分析提示中性肽链内切酶（NEP）水平与心肌梗死之间存在关联。
目的是评估再灌注后血浆NEP水平是否可作为梗死面积（IS）的替代指标，或预测急性ST段抬高型心肌梗死（STEMI）患者的不良结局。
我们对203例因行直接经皮冠状动脉介入治疗而转诊的STEMI患者进行了前瞻性队列研究。通过酶联免疫吸附测定法在入院时（t0）、再灌注后4小时（t4）以及21例患者亚组中的7个时间点（t0、t4、t12、t24、t48、第7天和第30天）测量循环可溶性NEP。在1个月时通过心脏磁共振测量IS和左心室射血分数（LVEF）。在12个月随访时收集不良心血管结局。
203例患者的t0和t4时NEP水平中位数分别为88.3 pg/mL（四分位间距[IQR][14; 375.4]）和101.5 pg/mL（IQR[18.5; 423.8]）。这些水平在1个月内保持不变（P = 0.70）。NEP水平与IS（P = 0.51）或LVEF（P = 0.
