Practical use of the markers for prediction of adverse left ventricular remodeling after acute ST segment elevation myocardial infarction

Abstract

Objective — to determine the most important markers for predicting of the development of prediction of adverse left ventricular (LV) remodeling in patients within 1 year after acute ST‑segment elevation myocardial infarction (STEMI).
 Materials and methods. The study involved 134 patients with acute STEMI, 95 (70.9 %) men and 39 (29.1 %) women, who satisfied inclusion criteria and had no exclusion criteria. All of them were hospitalized in the emergency department of L.T. Mala National Therapy Institute of NAMS of Ukraine from January 2018 to February 2021. All patients underwent myocardial revascularization by percutaneous coronary intervention (PCI) within 2 — 12 hours after the event in the V. T. Zaytsev Institute of General and Emergency Surgery. TIMI — 3 flow was restored in all 134 patients. Within 1 — 3 days after revascularization patients were transferred to the research center.
 Late adverse LV remodeling was defined as elevated LV end diastolic volume (LVEDV) > 10 % and/or LV end systolic volume (LVESV) > 10 % within 1 year after the index event. Serum soluble tumor suppressor‑2 (sST2) levels were determined by enzyme‑linked immunosorbent assay (Presage ST2 Assay, Critical Diagnostics, USA), N‑Terminal Pro‑Brain Natriuretic Peptide (NT‑proBNP) was detected by R&D Systems GmbH, Wiesbaden‑Nordenstadt, Germany), macrophage inhibitory factor (MIF) in blood serum serum was determined by enzyme‑linked immunosorbent assay RayBio®Human MIF ELISA KIT, USA). Statistical analysis was performed using Statistica 8.0 (Stat Soft Inc, USA).
 Results. Patients were divided into two groups: group 1 included 48 patients with adverse LV remodeling and group 2 consisted of 86 patients without LV remodeling. Uni‑ and multivariate log‑regression analysis demonstrated that LV ejection fraction (EF), MIF, number of damaged coronary vessels, sST2, longitudinal strain were independent predictors of adverse LV remodeling. Analysis of ROC curves showed that the cumulative value of markers such as MIF, ST2, longitudinal strain, number of damaged vessels, LV ejection fraction (AUC = 0.718; p < 0.0001, 95 %, CI 0.634 — 0.792) allows to identify patients with high risk of the development of adverse LV remodeling in patients within 1 year after acute STEMI. The formula with these markers was found out, that can be used to predict adverse LV remodeling: the prognosis of positive effect at Y ≥ 0.5, negative — at Y < 0.5.
 Conclusions. The study results demonstrated that LV ejection fraction, MIF, number of damaged coronary arteries, sST2, and global longitudinal strain can be used as predictors of adverse LV remodeling.