Iaremenko Oleg B, Iordanova Nataliia Kh, Dudka Petro F, Kuchmerovska Tamara M
Department of Internal Medicine No. 3, Bogomolets National Medical University, 26, Petra Zaporozhtsa Str., Kyiv, 02125, Ukraine.
Department of Vitamin and Coenzyme Biochemistry, Palladin Institute of Biochemistry of National Academy of Sciences of Ukraine, 9, Leontovych's str., Kyiv, 01054, Ukraine.
Amino Acids. 2022 Sep;54(9):1295-1310. doi: 10.1007/s00726-022-03182-0. Epub 2022 Jul 2.
Nowadays, the problem of preventing acute heart failure (AHF) in patients with ST-elevation myocardial infarction (STEMI) and preserved left-ventricular ejection fraction (pLVEF) is still not completely resolved, especially in late-presented patients. The purpose of study was: (1) assessment of free plasma amino acid (PAA) alterations in STEMI patients [not receiving reperfusion therapy (RT)], depending on sex and LVEF; (2) analysis of development of late/persistent AHF more than 48 h after admission (pAHF) in STEMI patients with pLVEF depending on PAA levels. This prospective cohort study included 92 STEMI patients (33 women and 59 men), not receiving RT. The free PAA were investigated by ion-exchange liquid-column chromatography. The women had significantly higher PAA levels than men in general cohort and cohort with pLVEF (n = 69). There were associations between female sex and pAHF in general cohort (OR 3.7, p = 0.004) and cohort with pLVEF (OR 11.4, p = 0.0001) by logistic regression. The association between pAHF and glycine level [OR 2.5, p < 0.0001; AUC 0.84, p < 0.0001; 86.7% sensitivity and 77.8% specificity for > 2.6 mg/dL] was revealed in cohort with pLVEF (including female and male). Glycine remained a predictor of pAHF with pLVEF by multivariable logistic regression adjusting for comorbidities, demographic and clinical variables. Higher rate of pAHF in female than in male STEMI patients with pLVEF is associated with higher plasma glycine in women. The glycine level may be genetically determinated by female sex. The plasma glycine > 2.6 mg/dL is a predictor of pAHF in STEMI with pLVEF (including female and male).
目前，在ST段抬高型心肌梗死（STEMI）且左心室射血分数保留（pLVEF）的患者中，预防急性心力衰竭（AHF）的问题仍未完全解决，尤其是在就诊较晚的患者中。本研究的目的是：（1）评估STEMI患者[未接受再灌注治疗（RT）]中游离血浆氨基酸（PAA）的变化，根据性别和左心室射血分数；（2）分析pLVEF的STEMI患者入院后48小时以上发生晚期/持续性AHF（pAHF）的情况，根据PAA水平进行分析。这项前瞻性队列研究纳入了92例未接受RT的STEMI患者（33名女性和59名男性）。通过离子交换液相柱色谱法研究游离PAA。在总体队列和pLVEF队列（n = 69）中，女性的PAA水平显著高于男性。通过逻辑回归分析，在总体队列（OR 3.7，p = 0.004）和pLVEF队列（OR 11.4，p = 0.0001）中，女性性别与pAHF之间存在关联。在pLVEF队列（包括女性和男性）中，发现pAHF与甘氨酸水平之间存在关联[OR 2.5，p < 0.0001；AUC 0.84，p < 0.0001；对于> 2.6 mg/dL，敏感性为86.7%，特异性为77.8%]。通过对合并症、人口统计学和临床变量进行多变量逻辑回归分析，甘氨酸仍然是pLVEF患者发生pAHF的预测因素。pLVEF的女性STEMI患者中pAHF的发生率高于男性，这与女性较高的血浆甘氨酸水平有关。甘氨酸水平可能由女性性别遗传决定。血浆甘氨酸> 2.6 mg/dL是pLVEF的STEMI患者发生pAHF的预测因素（包括女性和男性）。
