Cardiology Division, State University of Campinas, Campinas, São Paulo, Brazil; Laboratory of Atherosclerosis and Vascular Biology, State University of Campinas, Campinas, São Paulo, Brazil.
Cardiology Division, State University of Campinas, Campinas, São Paulo, Brazil.
Atherosclerosis. 2019 Feb;281:9-16. doi: 10.1016/j.atherosclerosis.2018.12.002. Epub 2018 Dec 6.
Coronary reperfusion with HDL from healthy volunteers attenuates ischemia and reperfusion injury in animal models. In myocardial infarction (MI) patients, such an interaction is unclear. Hence, our first objective was to verify if there is interaction between HDL-C and MI mass in patients and the role of coronary reperfusion in the interaction. Furthermore, we investigated whether the effect in MI size of reperfusion with HDL obtained from healthy participants or MI patients could differ.
HDL-C was measured the first day after MI and MI mass was quantified by cardiac magnetic resonance (n = 94) and peak CKMB (n = 393). In an ex vivo rat heart model, we compared MI area and dP/dt max after coronary reperfusion with HDL from MI patients or healthy volunteers.
HDL-C above the median (35 mg/dL) was associated with higher peak CKMB [255 (145-415) vs. 136 (84-287) UI/L; p = 0.02], higher MI mass [17 (9-21) vs. 10 (6-14) g; p < 0.01] and lower left ventricular ejection fraction [47 (34-53) vs. 51 (43-59); p = 0.02] than their counterparts. In restricted cubic spline and multivariate linear regression, HDL-C was directly associated with peak CKMB (p < 0.01) and MI mass (p < 0.01) only in reperfused patients with time to reperfusion <4 h. Reperfusion with healthy HDL, but not from MI patients, reduced MI mass (p < 0.01) and improved dP/dt max (p = 0.02).
In MI patients undergoing early coronary reperfusion, HDL-C levels at admission are directly associated with MI size. In contrast to healthy HDL, reperfusion with HDL from MI patients do not reduce MI area in an ex vivo animal model.
来自健康志愿者的高密度脂蛋白（HDL）进行冠脉再灌注，可减轻动物模型的缺血再灌注损伤。在心肌梗死（MI）患者中，这种相互作用尚不清楚。因此，我们的首要目标是验证 HDL-C 与 MI 患者的 MI 质量之间是否存在相互作用，以及冠脉再灌注在这种相互作用中的作用。此外，我们还研究了从健康参与者或 MI 患者中获得的 HDL 进行再灌注对 MI 大小的影响是否存在差异。
在 MI 后第一天测量 HDL-C，通过心脏磁共振（n=94）和肌酸激酶同工酶 MB 峰值（n=393）来量化 MI 质量。在离体大鼠心脏模型中，我们比较了再灌注来自 MI 患者或健康志愿者的 HDL 后 MI 面积和 dp/dt max。
HDL-C 高于中位数（35mg/dL）与肌酸激酶同工酶 MB 峰值更高[255（145-415）比 136（84-287）UI/L；p=0.02]、MI 质量更高[17（9-21）比 10（6-14）g；p<0.01]和左心室射血分数更低[47（34-53）比 51（43-59）；p=0.02]相关。在限制性立方样条和多元线性回归中，仅在再灌注时间<4 小时的再灌注患者中，HDL-C 与肌酸激酶同工酶 MB 峰值（p<0.01）和 MI 质量（p<0.01）直接相关。与 MI 患者的 HDL 相比，用健康的 HDL 进行再灌注可减少 MI 质量（p<0.01）并改善 dp/dt max（p=0.02）。
在接受早期冠脉再灌注的 MI 患者中，入院时的 HDL-C 水平与 MI 大小直接相关。与健康的 HDL 相反，在离体动物模型中，用 MI 患者的 HDL 进行再灌注不会减少 MI 面积。
