Abstract
Primary ventricular fibrillation (PVF) is a major driver of cardiac arrest in the acute phase of ST-segment elevation myocardial infarction (STEMI). Enrichment of cardiomyocyte plasma membranes with dietary polyunsaturated fatty acids (PUFA) reduces vulnerability to PVF experimentally, but clinical data are scarce. PUFA status in serum phospholipids is a valid surrogate biomarker of PUFA status in cardiomyocytes within a wide range of dietary PUFA. In this nested case–control study (n = 58 cases of STEMI-driven PVF, n = 116 control non-PVF STEMI patients matched for age, sex, smoking status, dyslipidemia, diabetes mellitus and hypertension) we determined fatty acids in serum phospholipids by gas-chromatography, and assessed differences between cases and controls, applying the Benjamini–Hochberg procedure on nominal P-values to control the false discovery rate (FDR). Significant differences between cases and controls were restricted to linoleic acid (LA), with PVF patients showing a lower level (nominal P = 0.002; FDR-corrected P = 0.027). In a conditional logistic regression model, each one standard deviation increase in the proportion of LA was related to a 42% lower prevalence of PVF (odds ratio = 0.58; 95% confidence interval, 0.37, 0.90; P = 0.02). The association lasted after the inclusion of confounders. Thus, regular consumption of LA-rich foods (nuts, oils from seeds) may protect against ischemia-driven malignant arrhythmias.
Highlights
Primary ventricular fibrillation (PVF) is a major driver of cardiac arrest in the acute phase of ST-segment elevation myocardial infarction (STEMI)
We found no differences in age, sex, smoking status, or prevalence of treated dyslipidemia, diabetes mellitus or hypertension
When comparing serum phospholipids status of main fatty acids at hospital admission by study group, significant differences were restricted to linoleic acid (LA), with PVF patients showing a lower compared with matched controls
Summary
Primary ventricular fibrillation (PVF) is a major driver of cardiac arrest in the acute phase of ST-segment elevation myocardial infarction (STEMI). We hypothesized that in patients with ST-elevation myocardial infarction (STEMI), cardiac enrichment in specific fatty acids resulting from the consumption of fat-rich foods during the weeks prior to the event would influence the vulnerability of the myocardium to develop PVF. To address this issue, at hospital admission for STEMI, we performed lipidomics in 58 patients who developed PVF and in 116 non-PVF controls matched for cardiovascular risk factors, searching for associations between fatty acid species and incident PVF. Given that routine myocardial biopsy is not safe in the acute phase of STEMI, we determined fatty acidsin serum phospholipids, the status of which changes in parallel with heart phospholipids within a wide range of dietary fats[12]
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