First Day Of Acute Myocardial Infarction Research Articles

PROGNOSTIC VALUE ENDOTHELIAL MONOCYTE ACTIVATING POLYPEPTIDE – ІІ IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN COMBINATION WITH 2 DIABETES MELLITUS AS A MARKER OF RECURRENT CARDIOVASCULAR EVENTS WITHIN 6 MONTHS OF OBSERVATION

The aim of the research. Analyze the prognostic value of endothelial monocyte activating polypeptide – ІІ as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes mellitus within 6 months of follow-up after a coronary event.
 Materials and methods. The research involved 120 patients. All subjects were included in 2 groups: group 1 - patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (DM), group 2 - patients with AMI (n = 50). The control group included 20 healthy individuals.
 Examination of patients was performed on the basis of the cardiology department for patients with acute myocardial infarction KNP "City Clinical Hospital №27" HMR and the 1st cardiology department of Kharkiv Clinical Hospital by rail №1 branch "Health Center" of the Joint Stock Company "Ukrainian Railways" .
 The participants of the research on the first day of AMI were determined the level of human endothelial monocyte activating polypeptide – ІІ (EMAP-II) in the serum using enzyme-linked immunosorbent assay using a commercial test system manufactured by Bioassay Technology Laboratory (China) in accordance with the enclosed instructions on enzyme-linked immunosorbent assay "Labline-90" (Austria).
 General clinical and instrumental examinations were performed on patients who were part of the 1st, 2nd groups and control groups.
 People who participated in the research were informed about the purpose, objectives, materials and methods of the research by signing an informed consent to participate in it. During the research, measures were taken to ensure the anonymity of each of its participants.
 Statistical processing of survey results was performed using software package StatSoft Inc USA - "Statistica 6.0".
 Research results. The average level of EMAP-II in patients who were in the 1st group was 4.54 ± 0.331 ng / ml, the 2nd - 2.74 ± 0.21 ng / ml, in the control group - 1.1 ± 0.037 ng / ml (p <0.05).
 A recurrent cardiovascular event in the form of recurrent AMI occurred in 19 patients (27.14%) who were part of the 1st group and in 7 patients (14%) who belonged to the 2nd group.
 The research found that the value of EMAR-II> 5.42 μmol / l in patients with AMI in combination with type 2 diabetes and> 2.64 μmol / l in patients with AMI without concomitant type 2 DM is a predictor recurrence of AMI within 6 months of follow-up after a coronary event.
 Based on the results of the research, a multifactor logistic regression model for the prognosis of recurrent AMI in patients with AMI in combination with type 2 DM was developed using EMAR-II for 6 months of follow-up after a coronary event.
 Conclusions. Thus, the level of endothelial monocyte activating polypeptide – ІІ in patients with acute myocardial infarction correlates with the presence of comorbid pathology in the form of type 2 diabetes mellitus, having the highest level in its presence, reflecting endothelial dysfunction that pathogenetically combines these diseases.
 According to the above, to date, the question remains about the prognostic value of endothelial monocyte activating polypeptide – ІІ in acute myocardial infarction in patients with concomitant type 2 diabetes mellitus during the 6-month follow-up period after a cardiovascular event.
 It is advisable to further research the rate of endothelial dysfunction - endothelial monocyte activating polypeptide – ІІ as a predictor of recurrent cardiovascular events in patients with acute myocardial infarction in combination with concomitant type 2 diabetes mellitus within 6 months after the coronary event.

Asymmetric dimethylarginine – a marker of repeated cardiovascular events in patients with comorbid pathology

Annotation. Today, diseases of the cardiovascular system retain their leading position among the incidence in the world. The presence of comorbid pathology in the form of type 2 diabetes mellitus (DM) significantly complicates the course of these diseases, worsening its prognosis. The aim of the study: to analyze the prognostic value of asymmetric dimethylarginine (ADMA) as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes for 6 months of follow-up. 120 patients were examined: group 1 – patients with acute myocardial infarction (AMI) in combination with type 2 diabetes mellitus (n=70), group 2 - patients with isolated AMI (n=50). The control group included 20 practically healthy individuals. All patients underwent general clinical and instrumental examinations, on the first day of AMI the level of ADMA was determined using a commercial test system "Human Asymmetrical Dimethylarginine ELISA". Statistical processing of the obtained data was performed using the software package StatSoft Inc, USA – "Statistica 6.0". The analysis of the average level of ADMA showed a significantly higher value of this indicator in patients with AMI in combination with type 2 DM than in patients without concomitant type 2 DM 2.57 times (1.57±0.11 μmol / l and 0.61±0.06 μmol / l, respectively), (p<0,05. ADMA level >1,72 μmol / l in patients with AMI in combination with type 2 DM and >0,69 μmol / l in patients with AMI without concomitant type 2 DM was identified as a predictor of recurrent acute myocardial infarction within 6 months of follow-up. Thus, the level of ADMA was higher in the presence of comorbid pathology in the form of type 2 DM in patients with AMI, reflecting endothelial dysfunction combining disease. It is advisable to further study this indicator of endothelial dysfunction as a predictor of the adverse course of AMI in combination with concomitant type 2 DM.

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study.

Heart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI. The gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages. The percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI. A higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study

IntroductionHeart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI. MethodsThe gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages. ResultsThe percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI. ConclusionA higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

Нові можливості оцінювання ризику розвитку госпітальних ускладнень у хворих з гострим інфарктом міокарда з елевацією сегмента ST за даними вивчення клітинного складу крові

The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (> 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (p<0.001 and p<0.0005, respectively). When the value of LTI > 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (p<0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.

Alteration of metabolic genes in peripheral blood isolated from patients with acute myocardial infarction

Accumulating evidence suggests that molecular alterations of peripheral leucocytes are possible diagnostic markers of acute myocardial infarction (AMI). Changed lipid/glucose metabolism is a prominent feature of the pathogenesis of AMI. Silent mating type information regulation 2 homolog 1 (SIRT1) and peroxisome proliferator-activated receptor gamma coactivator factor-α (PGC-1α) regulate mitochondrial function and energy metabolism. Thus, the gene expression of SIRT1 and PGC-1α in peripheral leucocytes isolated from AMI patients and their association with dyslipidemia have been evaluated. Fifty-five male subjects were divided into 40 patients with AMI and 15 healthy control subjects. Peripheral blood samples were obtained on the first day of AMI. Lipid profile parameters were assessed spectrophotometrically. Relative SIRT1 and PGC-1α expression were measured by real-time PCR. Compared with the control group, SIRT1 and PGC-1α expression were significantly decreased in the AMI group. SIRT1 expression was significantly negatively correlated with the age of the participants. SIRT1 expression was significantly positively correlated with PGC-1α expression. Both SIRT1 and PGC-1α expression were negatively correlated with markers of dyslipidemia. In conclusion, SIRT1 and PGC-1α expression are reduced in the acute phase of AMI, which addresses their possible role as potential biomarkers for AMI.

MiR-22-5p revealed as a potential biomarker involved in the acute phase of myocardial infarction via profiling of circulating microRNAs.

Acute myocardial infarction (AMI) is a life-threatening episode of coronary artery disease. Recently, circulating myocardial-derived microRNAs (miRNAs) have been reported as potential biomarkers of infarction. The present study aimed to identify differentially expressed miRNAs in patients with ST-segment elevation myocardial infarction that could be potentially dysregulated in response to early myocardial damage. miRNA expression profile analysis was performed using the Serum/Plasma Focus miRNA Polymerase Chain Reaction (PCR) panel of Exiqon A/S (Vedbaek, Denmark) on plasma samples of patients on the first day of AMI (admission) and on samples from the identical patients collected six months following AMI. Selected miRNAs were validated by reverse transcription‑quantitative PCR (RT‑qPCR) using independent patients with AMI and a control group of patients with a stable coronary artery disease. Thirty‑two species of plasma miRNA were differentially expressed (P<0.05) on admission compared with six months following AMI. Subsequent validation in an independent patient group confirmed that miR‑133b and miR‑22‑5p were significantly up‑regulated in the serum of patients with AMI. The receiver operating characteristic (ROC) curve analysis demonstrated a diagnostic utility for miR-22-5p, which has not previously been reported to be associated with AMI. Among the selected miRNAs, miR‑22‑5p represents a novel promising biomarker for the diagnosis of AMI.

Prognostic Significance of NT-proBNP Levels in Patients over 65 Presenting Acute Myocardial Infarction Treated Invasively or Conservatively.

Objectives. Assessment of prognostic significance of NT-proBNP level and the effects of invasive (I) and conservative (C) treatment of acute myocardial infarction (AMI) in patients over 65. Materials and Methods. One-year survival was assessed in 286 consecutive patients with AMI aged 65–100 (79 ± 8) subjected to I or C treatment (136 and 150 individuals), respectively. Results. 245 (85%) patients survived in-hospital stay: 124 (91.1%) received I treatment and 121 (80.6%) received C treatment. Heart failure (HF) was diagnosed in 30 patients receiving I treatment (22.6%) and in 71 subjected to C treatment (47.3%), p < 0,0001. NT-proBNP levels in the latter group were significantly higher than in the 185 patients without HF (12311 ± 13560 pg/mL versus 4773 ± 8807 pg/mL, p < 0.0001). NT-proBNP levels after coronary angioplasty were lower than in patients receiving C treatment (5922 ± 10250 pg/mL versus 8718 ± 12024 pg/mL, p = 0.0002). Left ventricular ejection fraction was significantly higher in I patients than in C patients (47 ± 13% versus 42 ± 11.6%, p = 0.004). During the one-year follow-up, 82.3% of I patients and 61.2% of the C patients survived (p < 0.0003). There was a significantly lower probability of death at NT-proBNP below 8548.5 pg/mL. Conclusions. The NT-proBNP level in the first day of AMI is a good prognosticator. One-year follow-up prognosis for patients who received I treatment in the AMI is better than that for C patients. I patients exhibit superior left ventricular function after angioplasty and in the follow-up.

Serum and Saliva Levels of Ischemia‐Modified Albumin in Patients with Acute Myocardial Infarction

Ischemia-modified albumin (IMA) is a novel marker for diagnosis of myocardial ischemia and it is considered as a serum marker. The aim of the study was to evaluate salivary IMA levels in patients with acute myocardial infarction (AMI) and to determine the relation between serum and salivary IMA levels. A total of 60 patients with AMI and 40 control subjects who are age and sex matched with AMI group were included in our study. The diagnosis of AMI was based on the WHO classification criteria. All patients underwent the clinical assessment, consisting of electrocardiography, and serum cardiac markers. Serum and salivary IMA levels were measured at the first and second days of AMI by using a colorimetric method. Serum IMA levels were significantly higher in the first and second day of AMI patients, however, salivary IMA levels were significantly higher in the first day of AMI patients compared to the control (P < 0.05). There was a positive correlation between salivary IMA levels and serum IMA levels both in the first and second day of AMI patients (r = 0.298, P < 0.05; r = 0.319, P < 0.05, respectively). We concluded that salivary IMA levels at the first day of AMI could be used as an alternative marker to serum IMA levels for diagnosis of AMI.

Role of Lymphocytes in Heart Disease

To the Editor: Recently, Ommen et al1 published in Circulation a very important observation: that relative lymphocyte concentration could be a prognostic marker in patients with symptomatic heart failure. I would like to add something about the importance of the cellular immune system in cardiovascular disease. I have shown that in acute myocardial infarction (AMI), a low CD4/CD8 ratio and low CD4 cell count on the first day of AMI strongly correlated with low ejection fraction and …

Predictive value of indium-111 antimyosin uptake for improvement of left ventricular wall motion after thrombolysis in acute myocardial infarction

In 21 patients treated with thrombolysis for acute myocardial infarction (AMI), the degree of myocardial uptake of indium-111 monoclonal antimyosin antibodies injected within 24 hours after onset of AMI was compared with the degree and extent of regional asynergy on admission and discharge, as assessed by 2-dimensional echocardiography. On the first day of AMI, 80 MBq of indium-111 antimyosin was injected and planar images were made 24 hours later. Indium-111 antimyosin uptake was evaluated for count density index (count density of infarct zone/left lung count density) in the left anterior oblique projection, in which the infarction zone was well displayed in all patients. Using 2-dimensional echocardiography, the left ventricle was divided into 13 segments and evaluated for regional asynergy, which was considered severe (akinesia or dyskinesia) or mild (hypokinesia). The extent of regional asynergy was measured by the number of asynergic segments. All 21 patients had severe regional asynergy on admission. Nine of 21 showed only mild regional asynergy on discharge and 12 of 21 had persistent severe regional asynergy in at least 1 segment. The count density index was significantly lower in patients with mild regional asynergy on discharge compared with patients with severe regional asynergy (1.63 ± 0.27 vs 2.50 ±0.42, p < 0.01). In 13 patients a decrease in the number of akinetic segments was seen between admission and discharge, whereas in 8 patients this number was unchanged; the count density index was, respectively, 1.77 ± 0.32 and 2.71 ± 0.37 (p < 0.01). It is therefore concluded that early count density index can predict wall motion improvement in the post-AMI patient treated with thrombolysis.

Significance of precordial ST-segment depression in inferior acute myocardial infarction as determined by echocardiography

Despite numerous studies, the significance of precordial ST-segment depression in inferior wall acute myocardial infarction (AMI) remains unclear. No clinical studies have used 2-dimensional (2-D) echocardiography to compare AMI location in patients with or without so-called reciprocal ST changes. Therefore, the clinical, electrocardiographic, echocardiographic and angiographic features of 22 patients with their first transmural inferior AMI were prospectively examined. During the first day of AMI an echocardiographic mapping of the area of necrosis was obtained using all conventional views and a ventricular segmentation related to anatomic landmarks. Patients were categorized according to the presence (group I, n = 13) or absence (group II, n = 9) of precordial ST-segment depression, defined as more than 1 mm, measured 80 ms after the J point in at least 2 of the leads V 1 to V 4. Basal posterolateral akinesia was observed in 11 of the 13 patients in group I and in no patient in group II (p < 0.001). Posterior right ventricular free wall akinesia was more frequent in group II (p < 0.02). There was no difference in the prevalence of significant left anterior descending artery (LAD) narrowing (group I, 4 patients; group II, 3 patients). Posterolateral involvement should be strongly considered in the presence of precordial ST-segment depression in association with transmural inferior AMI.