Abstract
Despite continuous advances in diagnostic and therapeutic methods, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Considering the role of inflammation in AMI etiopathogenesis, we aimed to explore the role of a group of three inflammatory cytokines (IL-1RA, IL-6 and resistin) as an independent prognostic factor for LVR assessed by 3D echocardiography and MACE in patients with STEMI. We enrolled 41 patients with STEMI who underwent primary PCI. We assessed the occurrence of LVR (defined as an increase of over 20% in end-diastolic left ventricular volume at 6 months compared with baseline values) and MACE. Using the enzyme-linked immunosorbent assays (ELISA) method, we measured plasmatic levels of IL-6, IL-1RA and resistin (within 48 h after AMI and at 6 months). Out of 41 STEMI patients, 20.5% presented signs of LVR at follow up, and in 24.4%, MACE occurred. In univariate logistic regression analysis, baseline levels of IL-6 (OR = 1.042, p = 0.004), IL-1RA (OR = 1.004, p = 0.05) and resistin (OR = 1.7, p = 0.007) were all significantly associated with LVR. ROC analysis showed that the three cytokines as a group (AUC 0.946, p = 0.000) have a better predictive value for LVR than any individual cytokine. The group of cytokines also proved to have a better predictive value for MACE together than separately (AUC = 0.875, p = 0.000 for ROC regression model). IL-6, IL-1RA and resistin plasma levels at baseline have a good predictive value both as independent variables and also as a group for the development of adverse LVR and MACE at 6 months follow up after STEMI.
Highlights
The prognosis of STEMI is mainly determined by the extent of irreversible myocardial injury and LVR
Occurring in about 30% of the patients with STEMI treated by primary PCI, LVR is a precursor for the development of heart failure (HF) and can lead to arrhythmias and other complications, increasing cardiovascular morbidity and mortality [1]
Out of 53 patients initially included in this study, 7 were lost at follow up and 5 had poor acoustic window leaving a final study population of 41 patients with STEMI treated by primary PCI
Summary
The prognosis of STEMI is mainly determined by the extent of irreversible myocardial injury and LVR. After AMI, the left ventricle undergoes a series of histopathological and structural changes that can lead to adverse LVR [1]. Occurring in about 30% of the patients with STEMI treated by primary PCI, LVR is a precursor for the development of heart failure (HF) and can lead to arrhythmias and other complications, increasing cardiovascular morbidity and mortality [1]. The identification of patients with a high likelihood of LVR has essential implications for risk stratification after AMI. Detection and prompt therapeutic measures are crucial in order to improve the quality of life and survival in this high-risk group
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