Wan Jun, Xu Feng, Yin Chunlin, Jiang Yang, Chen Cai, Wang Yulin, Zuo Heping, Cheng Jinglin, Li He
Department of Emergency Internal Medicine, the Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui 230001, China.
Department of Emergency Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui 230001, China.
Am J Med Sci. 2025 Apr;369(4):479-484. doi: 10.1016/j.amjms.2024.11.009. Epub 2024 Nov 27.
Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.
To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.
In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20 % was defined as LVR.
The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95 % CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95 % CI: 0.7067 to 0.8744; P < 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95 % CI: 0.7345 to 0.8896; P < 0.0001).
These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.
缺氧诱导因子-1α（HIF-1α）在涉及心肌纤维化和肥大的心室重构过程中起重要作用，但ST段抬高型心肌梗死（STEMI）后早期HIF-1α水平对预测左心室重构（LVR）的临床意义尚未完全阐明。
基于超声心动图参数研究HIF-1α对STEMI后LVR的预测价值。
在这项前瞻性观察研究中，从183例首次再灌注的前壁ST段抬高型心肌梗死（STEMI）患者发病后12小时内采集血浆样本，采用酶联免疫吸附测定（ELISA）法检测HIF-1α水平。在基线和出院后12个月时，所有患者均接受重复超声心动图检查。超声心动图参数从基线到12个月的变化用于反映心室结构和功能的变化。舒张末期容积增加≥20%被定义为LVR。
HIF-1α水平与超声心动图参数（ΔLVEF、ΔLVEDD以及ΔLVEDV）的变化高度相关。在随访期间，HIF-1α浓度较高的患者LVR发生率较高、心室功能较差且无主要不良心血管事件生存率较低。多因素分析显示单点HIF-1α是LVR的独立预测因子（比值比[OR]：4.813；95%可信区间：1.553至14.918；P = 0.006）。HIF-1α水平预测LVR的曲线下面积（AUC）为0.7905（95%可信区间：0.7067至0.8744；P < 0.0001）。HIF-1α与N末端脑钠肽前体（NT-proBNP）联合使用使AUC有利地增加至0.8121（95%可信区间：0.7345至0.8896；P < 0.0001）。
这些结果表明血清HIF-1α水平可独立预测STEMI后的LVR。
