Abstract

CCN2/Connective tissue growth factor seems to be involved in development of cardiac hypertrophy and fibrosis, but a possible cardioprotective role in left ventricular (LV) remodelling following myocardial infarction has also been suggested. The main objectives of the study were therefore to investigate whether circulating CCN2 levels were associated with infarct size, LV function, adverse remodelling or clinical outcome in two cohorts of patients with ST-elevation myocardial infarction (STEMI). CCN2 was measured in 988 patients 18 hours after PCI and clinical events were recorded after 55 months in the BAMI cohort. In the POSTEMI trial, serial measurements of CCN2 were performed in 258 STEMI patients during index hospitalisation and cardiac magnetic resonance imaging was performed in the acute phase and after 4 months. Clinical events were also recorded. There were no significant associations between levels of CCN2 and infarct size, LV ejection fraction, changes in LV end-diastolic or end-systolic volume, myocardial salvage or microvascular obstruction. There were no significant associations between CCN2 levels and clinical events including mortality, in either of the study cohorts. In conclusion, circulating levels of CCN2 measured in the acute phase of STEMI were not associated with final infarct size, left ventricular function or new clinical events.

Highlights

  • Adverse left ventricular (LV) remodelling, impaired myocardial salvage and heart failure development remain unresolved issues in patients with acute ST-elevation myocardial infarction (STEMI) despite modern reperfusion therapy

  • We wanted to investigate, whether levels of circulating CCN2 were associated with myocardial injury, remodelling, and clinical outcome in two separate cohorts of STEMI patients treated by primary percutaneous coronary intervention (PCI)

  • Possible associations with myocardial IR-injury, including myocardial salvage and ischaemic postconditioning, adverse remodelling and final infarct size assessed by cardiac magnetic resonance imaging (CMR) were explored in the Postconditioning in ST-Elevation Myocardial Infarction (POSTEMI) study, while studying associations between circulating CCN2 levels and clinical outcome was the main objective of the Biobanking in Acute Myocardial Infarction (BAMI) study

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Summary

Introduction

Adverse left ventricular (LV) remodelling, impaired myocardial salvage and heart failure development remain unresolved issues in patients with acute ST-elevation myocardial infarction (STEMI) despite modern reperfusion therapy. CCN2 is involved in a variety of biological processes including extracellular matrix synthesis, cell proliferation and angiogenesis It has been implicated in the pathogenesis of cardiac hypertrophy and fibrosis[4,5,6,7], and has been found to be upregulated in models of cardiac pressure-overload induced heart failure[6,8] and myocardial infarction (MI)[9,10], suggesting a role in cardiac remodelling. Possible associations with myocardial IR-injury, including myocardial salvage and ischaemic postconditioning, adverse remodelling and final infarct size assessed by cardiac magnetic resonance imaging (CMR) were explored in the Postconditioning in ST-Elevation Myocardial Infarction (POSTEMI) study, while studying associations between circulating CCN2 levels and clinical outcome was the main objective of the Biobanking in Acute Myocardial Infarction (BAMI) study

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