Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
Biomolecules. 2023 Sep 29;13(10):1470. doi: 10.3390/biom13101470.
Circulating small extracellular vesicles (sEVs) contribute to inflammation, coagulation and vascular injury, and have great potential as diagnostic markers of disease. The ability of sEVs to reflect myocardial damage assessed by Cardiac Magnetic Resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) is unknown. To fill this gap, plasma sEVs were isolated from 42 STEMI patients treated by primary percutaneous coronary intervention (pPCI) and evaluated by CMR between days 3 and 6. Nanoparticle tracking analysis showed that sEVs were greater in patients with anterior STEMI ( = 0.0001), with the culprit lesion located in LAD ( = 0.045), and in those who underwent late revascularization ( = 0.038). A smaller sEV size was observed in patients with a low myocardial salvage index (MSI, = 0.014). Patients with microvascular obstruction (MVO) had smaller sEVs ( < 0.002) and lower expression of the platelet marker CD41-CD61 ( = 0.039). sEV size and CD41-CD61 expression were independent predictors of MVO/MSI (OR [95% CI]: 0.93 [0.87-0.98] and 0.04 [0-0.61], respectively). In conclusion, we provide evidence that the CD41-CD61 expression in sEVs reflects the CMR-assessed ischemic damage after STEMI. This finding paves the way for the development of a new strategy for the timely identification of high-risk patients and their treatment optimization.
循环中小细胞外囊泡（sEVs）参与炎症、凝血和血管损伤，并且具有作为疾病诊断标志物的巨大潜力。sEVs 反映经皮冠状动脉介入治疗（pPCI）治疗的 ST 段抬高型心肌梗死（STEMI）患者心肌损伤的能力尚不清楚。为了填补这一空白，从 42 例接受 pPCI 治疗的 STEMI 患者中分离血浆 sEVs，并在第 3 至 6 天进行心脏磁共振（CMR）评估。纳米颗粒跟踪分析显示，前壁 STEMI 患者的 sEVs 较大（ = 0.0001），罪犯病变位于左前降支（LAD， = 0.045），且晚期血运重建患者的 sEVs 较大（ = 0.038）。心肌挽救指数（MSI）较低的患者 sEV 较小（ = 0.014）。存在微血管阻塞（MVO）的患者 sEV 较小（ < 0.002），血小板标志物 CD41-CD61 表达较低（ = 0.039）。sEV 大小和 CD41-CD61 表达是 MVO/MSI 的独立预测因子（OR [95%CI]：0.93 [0.87-0.98] 和 0.04 [0-0.61]）。总之，我们提供了证据表明，sEVs 中的 CD41-CD61 表达反映了 STEMI 后 CMR 评估的缺血性损伤。这一发现为开发一种新策略以及时识别高危患者并优化其治疗铺平了道路。
