PROGNOSTIC VALUE OF ENDOTHELIAL MONOCYTE ACTIVATING POLYPEPTIDE – ІІ ON THE DEVELOPMENT OF ACUTE LEFT VENTRICULAR FAILURE IN HOSPITAL PERIOD OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Introduction. 20% of patients with acute myocardial infarction are diagnosed as having type 2 diabetes: this is much higher than in the entire population. In the presence of this comorbid disease, the incidence of acute left ventricular failure with cardiogenic shock is also much higher than could be predicted based on the size of the infarction zone that poses a challenge for modern cardiology. Endothelial dysfunction is known to underlay the etiopathogenesis of acute myocardial infarction and concomitant type 2 diabetes. Endothelial monocyte activating polypeptide – ІІ is a multifunctional peptide with proinflammatory and angiogenesis properties, it activates a number of proinflammatory cytokines, inducing inflammatory changes in blood vessels. It plays a significant role in the process of myocardial tissue revascularization in acute myocardial infarction (AMI). The aim of this study is to investigate the relationship between the activity of endothelial monocyte activating polypeptide – ІІ and acute left ventricular failure in patients with acute myocardial infarction in hospital period and type 2 diabetes mellitus, as well as to evaluate the prognostic properties of endothelial monocytactating peptide II in this cohort of patients with following design of prognostic model. Material and methods. The study involved 120 patients (60 men and 60 women) with AMI, whose mean age was 66.35 ± 0.91 years, (p <0.05). The participants were divided into 2 groups: group 1 patients with concomitant type 2 diabetes (n = 70), group 2 patients with isolated AMI (n = 50). The control group included 20 healthy individuals. All participants underwent standard routine clinical and instrumental examinations. According to the objectives of this study, on the 1st day after AMI diagnosis was confirmed, the level of EMARII was evaluated in all participants using a commercial test system "Human Endothelial monocyte activating polypeptide – ІІ ELISA KIT". The findings data obtained were processed by the software package "Statistica 6.0" (StatSoft Inc, USA). Results. The patients of the 1 group had higher level of endothelial monocytic peptide-II 1.65 times than the patients of the 2nd group (4.54 ± 0.331 ng / ml vs. 2.74 ± 0.21 ng / ml, respectively, (p <0,05). In the control group, the average value of this indicator was 1.1 ± 0.037 ng / ml. Class IV by the Killip scale was detected in 44% of the patients included in the group of the 3rd tertile according to the level of endothelial monocyte activating polypeptide – ІІ. The value of endothelial monocyte activating polypeptide – ІІ > 6.45 ng / ml in patients of the 1 group and > 3.31 ng / ml in the patients of the 2 group is a predictor for occurrence of left-ventricular failure resulting in cardiogenic shock. Based on the results of the study, a multifactor logistic regression model for the prognosis of acute left-ventricular cardiac failure with cardiogenic shock in the hospital course of AMI in patients with type 2 diabetes was developed. Conclusions. Thus, endothelial monocyte activating polypeptide – ІІ acts as a predictor for acute left ventricular failure resulting in cardiogenic shock in the hospital period of acute myocardial infarction in patients with type 2 diabetes.