Level of matrix metalloproteinase-9 and myocardium remodeling in patients with acute postinfarction aneurism of left ventricle

Authors

  • V. D. Syvolap Zaporozhye state medical univercity,
  • S. M. Kyselov Zaporozhye state medical univercity,

DOI:

https://doi.org/10.14739/2310-1210.2013.6.20795

Keywords:

myocardial infarction, left ventricle aneurism, predictors of heart aneurism formation

Abstract

67 patients with diagnosis: Q-wave myocardial infarction – were examined. Level of matrix metalloproteinase-9, structural and functional indexes of myocardium remodeling were studied in patients with acute postinfarction aneurism of left ventricle. Early predictors of left ventricle aneurism formation were revealed in patients with acute Q-wave myocardial infarction.

 

Abstract

Background. Problem of acute myocardial infarction till nowadays remains relevant, because it’s one of the leading causes of mortality, morbidity and disability in most developed countries. Severity of postinfarction remodeling is a factor that determines the degree of myocardial dysfunction and prognosis of survival. During the first few days after the onset of AMI disproportionately thinned and stretched infarcted area, which is no longer able to resist to intraventricular pressure, which subsequently leads to an expansion of a heart attack until the formation of an aneurysm or heart failure. In this case, the structural and functional changes in the heart muscle affects both the affected and intact areas of the myocardium , marked by the passage of the phase of adaptive and maladaptive processes. Mechanisms of postinfarction remodeling caused by the interaction of cell as well as extracellular factors, starting immediately after coronary artery occlusion with the normal degradation of the extracellular matrix , migration of inflammatory cells to the site of damage and induction of biologically active peptides. In recent studies there was a high expression of MMP -9 in patients with acute coronary syndrome, showing the value of its serum concentration as a marker of inflammation, a predictor of restenosis and cardiovascular mortality in patients with coronary heart disease. This gives reason to explore the prognostic value of early detection of the level of MMP -9 in myocardial infarction as a marker of adverse postinfarction remodeling.

Methods. Sixty seven patients with acute myocardial infarction were examined and divided to two groups: first – thirty five patients with left ventricle aneurism, second – thirty two patients with uncomplicated acute Q-wave myocardial infarction. All patients were examined by general physical examination, standard laboratory tests, electrocardiography, echocardiography. Diagnostics of heart aneurism was done by clinical, electrocardiographical and echocardiographical data. Statistical analyses of the results was carried out on a personal computer with the help of a licensed program “Statistica” (version 6.0, Stat Soft Inc, USA).

Results. Among patients with left ventricle aneurism in comparison with uncomplicated acute myocardial infarction segment ST remains elevated till 3-d and 5-th day without dynamic changes of T-wave in anterior thoracic leads, it was mentioned significant predominance of left ventricle dilatation, mitral regurgitation, decreased systolic function of left ventricle, diastolic dysfunction of II type and high serum level of MMP-9. During correlation analysis there were revealed factors with strong significant direct and inverse correlations with left ventricle aneurism formation. By multivariate logistic regression it was formed equation including built reliable predictors of aneurism formation in acute period of Q-wave myocardial infarction.

Conclusions. Among patients with acute postinfarction aneurism it was revealed significant prevalence of MMP-9 serum level, strong direct correlation connection with left ventricle aneurism formation, high regression coefficient, that confirm significant role of MMP-9 in the process of postinfarction left ventricle aneurism formation. Significant predictors of left ventricle aneurism formation in patients with acute Q-wave myocardial infarction are age more than 65 years, quantity of myocardial infarctions in anamnesis, elevated systolic blood pressure in admission, segment ST elevation index on 3-d day of acute myocardial infarction, end-diastolic diameter of left ventricle, systolic and diastolic (2 type) dysfunction of left ventricle, mitral regurgitation, quantity of dyskinetic segments of left ventricle and high serum level of MMP-9.

 

References

Агеев Ф.Т. Сердечная недостаточность на фоне ишемической болезни сердца: некоторые вопросы эпидемиологии, патогенеза и лечения / Ф.Т. Агеев, А.А. Скворцов, В.Ю. Мареев, Ю.Н. Беленков // Русский медицинский журнал. – 2000. – № 15–16. – С. 622–626.

Белов Ю.В. Структурно-геометрические изменения миокарда и особенности центральной гемодинамики при постинфарктном ремоделировании левого желудочка / Ю.В. Белов, В.А. Вараксин // Кардиология. – 2003. – № 1. – С. 19–23.

Гороховский Б.И. Аневризмы и разрывы сердца / Б.И. Гороховский. – М.: МИА, 2001. – 1080 с.

Дзяк Г.В. Тип деградации фибронектина как новый

дополнительный фактор риска тромботических и геморрагических осложнений острого инфаркта миокарда с зубцом Q / Г.В. Дзяк, Е.А. Коваль, А.П. Иванов, А.И. Шевцова // Серце і судини. – К.: ВІТ-А-ПОЛ, 2007. – № 1(17). – С. 39–51.

Ена Я.М. Клиническая ценность определения фибронектина при внутренних болезнях /Я.М. Ена, Л.Ф. Коноплева, А.А. Чаяло // Клиническая медицина. – 2001. – №2. – С. 24–30.

Коваленко В.Н. Компетентность врачей, ответственность пациентов, адекватное финансовое обеспечение – пути решения проблем в кардиологии / В.Н. Коваленко, А.Н. Пархоменко // Здоров’я України. – 2008. – № 8 – С. 36–37.

Пархоменко А.Н. Украинский регистр острого инфаркта миокарда как фрагмент Европейского: характеристика больных, организация медицинской помощи и госпитальная терапия /А.Н. Пархоменко, Я.М. Лутай, Н. Даншан // Укр. мед. часопис. – 2011. – № 1 (81). – С. 20–24.

Сисакян А.С. Влияние фактора ангиогенеза на морфофункциональное состояние миокарда у крыс при экспериментальном инфаркте миокарда / А.С. Сисакян, В.А. Оганян, А.Б. Семерджян, М.В. Петросян, С.А. Сисакян, М.А. Гуревич // РКЖ. – 2008. – № 2. – С. 63–67.

Целуйко В.И. Особенности показателей гемодинамики и диастолической функции у больных с инфарктом миокарда заднейстенки левого желудочка с вовлечением правого желудочка/ В.И. Целуйко, Т.А. Лозовая, Д.А. Кныш, О.В. Дерновая // Український кардіологічний журнал. – 2012. – № 6. – С. 35–43.

Bayes De Luna Electrocardiography in Ischemic Heart Disease: Clinical and Imaging Correlations and Prognostic Implications / Bayes De Luna, M. Fiol-Sala – Blackwell Publishing, 2007. – 421 р.

Blankenberg S. Plasma concentrations and genetic variation of matrix metalloproteinase 9 and prognosis of patients with cardiovascular disease / S. Blankenberg, HJ. Rupprecht, O. Poirier et al. // Circulation. – 2003. – Vol. 107. – P. 1579–1585.

Birnbaum Y. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis / Y. Birnbaum, BJ. Drew // Postgrad Med J. – 2003. – Vol. 79. – P. 490–504.

Ferroni P. Serum metalloproteinase 9 levels in patients with coronary artery disease: a novel marker of inflammation / P. Ferroni, S. Basili, F. Martini et al. // J Investig Med. – 2003. – Vol. 51. – P. 295–300.

Fujll H. Patch repair of post-infarction pseudo- and subepicardial aneurysm of the left ventricle / H. Fujll, R. Hattory, M. Osako //J. Cardiovasc. Surg. – 2001. – № 42. – P. 49–51.

Kai H. Peripheral blood levels of matrix metalloproteases-2 and -9 are elevated in patients with acute coronary syndromes / H. Kai, H. Ikeda, H. Yasukawa et al. // J Am Coll Cardiol. – 1998. – Vol. 32. – P. 368–372.

Mickleborough L.L. Repair of dyskinetic or akinetic left ventricular aneurysm: results obtained with a modifi ed linear closure / L.L. Mickleborough, S. Carson, J. Ivanov // J. Thorac. Cardiovasc. Surg. – 2001. – № 121. – P. 675–682.

Swedberg K. Guidelines for Diagnosis and Treatment of Chronic Heart Failure / K. Swedberg et al. // Eur. Heart Journ. – 2005. – Vol. 26. – Р. 1115–1140.

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1.
Syvolap VD, Kyselov SM. Level of matrix metalloproteinase-9 and myocardium remodeling in patients with acute postinfarction aneurism of left ventricle. Zaporozhye medical journal [Internet]. 2014Jan.29 [cited 2024Apr.25];15(6). Available from: http://zmj.zsmu.edu.ua/article/view/20795

Issue

No. 6 (2013): Zaporozhye medical journal

Section

Original research

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