EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study
César Ríos-Navarro1, José Gavara1, Julio Núñez2
1Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
Introduction And Objectives:
Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI.
Methods:
We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated.
Results:
The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043).
Conclusions:
EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI.
Insights
Epithelial cell adhesion molecule (EpCAM) levels are linked to microvascular obstruction after heart attacks. Lower EpCAM indicates more severe obstruction and poorer long-term heart function following ST-segment elevation myocardial infarction (STEMI).
Area of Science:
- Cardiology
- Biomarkers
- Cardiac Imaging
Background:
- Microvascular obstruction (MVO) negatively impacts cardiac structure and prognosis in ST-segment elevation myocardial infarction (STEMI).
- Epithelial cell adhesion molecule (EpCAM) is an understudied biomarker in the context of MVO.
Purpose of the Study:
- To investigate the association between serum EpCAM levels and cardiac magnetic resonance (CMR)-derived MVO.
- To determine the relationship between EpCAM and long-term systolic function in STEMI patients.
Main Methods:
- Prospective study of 106 STEMI patients treated with percutaneous coronary intervention.
- Serum EpCAM levels measured 24 hours postreperfusion.
- CMR imaging performed at 1 week and 6 months post-STEMI to assess MVO and systolic function.
Main Results:
- Lower EpCAM levels correlated with extensive MVO and larger infarct size at 1 week post-STEMI.
- EpCAM was significantly associated with the presence of MVO in both univariate and multivariate analyses.
- Decreased EpCAM levels were linked to worse long-term systolic function, including reduced left ventricular ejection fraction and increased left ventricular end-systolic volume.
Conclusions:
- EpCAM is associated with the occurrence of MVO in acute phases of STEMI.
- EpCAM serves as a potential biomarker for adverse ventricular remodeling and long-term outcomes post-STEMI.
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