[Dynamics of Parameters of Transmitral Blood Flow and Markers of Myocardial Fibrosis in Patients with Myocardial
A V Osokina1, V N Karetnikova1, O M Polikutina1
1Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo.
Insights
Echocardiography indexes correlate with myocardial fibrosis markers one year after ST-segment elevation myocardial infarction (STEMI). These findings suggest ongoing fibrosis, potentially leading to chronic heart failure progression.
Area of Science:
- Cardiology
- Biochemistry
- Medical Imaging
Background:
- ST-segment elevation myocardial infarction (STEMI) can lead to long-term cardiac complications.
- Myocardial fibrosis, assessed by procollagen peptides, is a key factor in heart dysfunction post-MI.
- Echocardiography (EchoCG) provides crucial insights into cardiac structure and function.
Purpose of the Study:
- To investigate correlations between EchoCG parameters and myocardial fibrosis markers (PICP, PIIINP) up to one year post-STEMI.
- To assess changes in cardiac function and fibrosis markers in patients with different left ventricular ejection fractions (LVEF) post-STEMI.
Main Methods:
- 120 STEMI patients underwent EchoCG to evaluate cardiac dimensions, systolic and diastolic function, and pulmonary artery pressure.
- Serum concentrations of procollagen I C-terminal propeptide (PICP) and procollagen III N-terminal propeptide (PIIINP) were measured.
- Assessments were performed at baseline, day 12, and one year post-STEMI, with patients stratified by LVEF (≥50% vs. <50%).
Main Results:
- One year post-STEMI, diastolic dysfunction signs increased in patients with LVEF ≥50%, while systolic function worsened in both groups.
- Procollagen III N-terminal propeptide (PIIINP) levels correlated with diastolic function indexes (Em, E/e'), mean pulmonary arterial pressure (mPAP), and LVEF.
- In patients with LVEF <50%, procollagen I C-terminal propeptide (PICP) correlated with LVEF and early diastolic septal mitral annular velocity (e'), with a more significant PIIINP increase.
Conclusions:
- Direct correlations between PIIINP and diastolic function/hemodynamics were observed in patients with preserved LVEF (≥50%).
- In patients with reduced LVEF (<50%), PICP correlated with LVEF and diastolic function, and PIIINP showed a statistically significant increase.
- These findings indicate persistent myocardial fibrosis formation one year after STEMI, potentially driving chronic heart failure progression.
Abstract:
Aim To study possible correlations between echocardiography (EchoCG) indexes and markers of myocardial fibrosis, procollagen I C-terminal propeptide (PICP) and procollagen III N-terminal propeptide (PIIINP) during one year following ST-segment elevation myocardial infarction (STEMI).Material and methods 120 patients with STEMI were evaluated. EchoCG was used to assess dimensions and volumes of heart chambers, left ventricular (LV) systolic function, mean pulmonary arterial pressure (mPAP), and indexes of LV diastolic function (Em, early diastolic lateral mitral annular velocity; e', peak early diastolic septal mitral annular velocity; E / e', ratio of peak early diastolic transmitral inflow velocity and mitral annular velocity -, Е / А, ratio of peak early and late transmitral inflow velocities; DT, deceleration time of LV early diastolic filling). EchoCG indexes and serum concentrations of PICP and PIIINP were determined at 1 (point 1) and 12 (point 2) days of disease and one year after STEMI (point 3). The sample was divided into two groups: group 1 (n=86; 71.7 %) included patients with a LV ejection fraction (EF) ≥50 % and group 2 (n=34; 28.3 %) consisted of patients with LV EF ≤49 %.Results At one year, the number of patients with signs of diastolic dysfunction increased by 10% in group 1 whereas myocardial systolic dysfunction worsened in both groups. LV EF decreased in 15 (17.4%) patients of group 1 and in 4 (11.8%) patients of group 2. Concentrations of PIIINP were correlated with Em, E / e', mPAP, PICP, e', and LV EF.Conclusion Direct correlations between PIIINP concentrations and Em, E / e', and mPAP were found in the group with LV EF ≥50 %. In the group with LV EF <50 %, correlations were observed between PICP concentrations, LV EF, and e'. Also, in this group, the increase in PIIINP was statistically more significant. These results indicate continuing formation of myocardial fibrosis in a year following MI, which may underlie progression of chronic heart failure.
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