Oxidative stress markers predict early left ventricular systolic dysfunction after acute myocardial infarction
Dubravka Rajic1, Ivica Jeremic2,3, Sanja Stankovic4
1Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
Insights
Oxidative stress markers, including thiol groups and catalase, predict left ventricular systolic dysfunction and heart failure after ST-elevation myocardial infarction (STEMI). These biomarkers aid in risk stratification post-STEMI.
Area of Science:
- Cardiology
- Biochemistry
- Internal Medicine
Background:
- Successful primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) does not prevent all cases of left ventricular systolic dysfunction (LVSD) and acute heart failure (HF).
- Identifying high-risk patients early is crucial for targeted, aggressive therapies to improve outcomes.
- Biomarkers offer a potential avenue for risk stratification in STEMI patients.
Purpose of the Study:
- To investigate the association between oxidative stress markers and the development of LVSD and acute HF following STEMI.
- To determine if novel biomarkers can improve risk prediction beyond established markers.
Main Methods:
- 148 patients with first STEMI treated with primary PCI within 12 hours were analyzed.
- Assessed biomarkers included markers of necrosis (peak creatine kinase), myocardial stretch (BNP), inflammation (CRP, leucocytes, neutrophils), and oxidative stress (thiol groups, catalase, SOD, GR).
- Multivariate logistic regression was used to identify independent predictors of LVSD (LVEF ≤ 40%) and acute HF (Killip ≥ 2).
Main Results:
- Thiol groups, peak creatine kinase, anterior wall infarction, and age independently predicted reduced ejection fraction (LVEF ≤ 40%).
- Catalase, B-type natriuretic peptide (BNP), leucocyte count, neutrophil count, and left atrial size were independently associated with acute heart failure (Killip ≥ 2).
Conclusions:
- Thiol groups and catalase are identified as novel, independent predictors of LVSD and acute HF after STEMI, respectively.
- These oxidative stress markers, alongside traditional biomarkers, enhance risk stratification for STEMI complications.
- The findings suggest incorporating thiol groups and catalase measurements into routine clinical practice for improved patient management.
Background:
Despite successful primary percutaneous coronary intervention (PCI) after ST-segment elevation myocardial infarction (STEMI), some patients develop left ventricular systolic dysfunction (LVSD) and acute heart failure (HF). Identifying patients with an increased risk of developing LVSD by means of biomarkers may help select patients requiring more aggressive therapy.
Objectives:
The aim of this study was to evaluate the relationship between the levels of oxidative stress markers and development of LVSD and acute HF early after STEMI.
Material And Methods:
The study enrolled 148 patients with the first STEMI, who were treated by primary PCI < 12 h from the onset of symptoms. We assessed the impact of different biomarkers for developing LVSD and acute HF (Killip ≥ 2) including: markers of necrosis - peak creatine kinase (CK), markers of myocardial stretch - B-type natriuretic peptide (BNP), inflammatory markers - C-reactive protein (CRP), leucocyte and neutrophil count, as well as oxidative stress markers - total thiol groups, catalase, superoxide dismutase (SOD) and glutathione reductase (GR).
Results:
In multivariate analysis, thiol groups, peak CK, anterior wall infarction, and age were predictors of LVEF ≤ 40%. Out of 16 variables significantly associated with the Killip ≥ 2 in univariate logistic regression analysis, 5 appeared to be independently associated with acute HF in multivariate analysis: catalase, BNP, leucocytes, neutrophil count, and size of left atrium.
Conclusions:
In this study, we have shown for the first time that thiol groups and catalase are independent predictors of STEMI complication - LVSD and acute HF, respectively. Beside routine used biomarkers of necrosis and myocardial stretch, thiol groups and catalase may provide additional information regarding the risk stratification.
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