P428Prognostic significance of the biomarkers levels for evaluation of progressive ventricular remodeling in patients after acute coronary syndrome

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Abstract

Purpose

To assess the prognostic significance (3 months) of a biomarker levels of myocardium necrosis (troponin T, MB-creatine phosphokinase), inflammation (leucocytes, monocytes, high-sensitivity C-reactive protein (hsCRP), and myocardium remodeling (N-terminal pro-B-type natriuretic peptide (NT-proBNP), pro-matrix metalloprotease-1 (proMMP-1), matrix metalloprotease-9 (MMP-9), tissue inhibitor of the matrix metalloprotease-type 1 (TIMP-1)) in patients after acute coronary syndrome (ACS) for evaluation the risk of progressive ventricular remodeling.

Methods

153 patients with ACS were taken to investigation. ACS with ST-segment elevation was diagnosed in 69,1 % of cases; ACS without ST-segment elevation - in 30,9 %. Myocardial infarction was verified in 137 patients, in another cases a diagnosis unstable angina was established. The levels of MB-creatine phosphokinase and troponin T were tested for the first 24 hours of the disease course; matrix metalloproteases and their inhibitors (proMMP -1, MMP-9 and TIMP-1), leukocytes, monocytes, NT-proBNP and hsCRP — for the 3-5 days. Development of left ventricular remodeling had been evaluated on the base of EchoCG results.

Results

Development of the left ventricular remodeling was evaluated in comparison with EchoCG indicators on 5th days versus 3th months. According to investigation results all patients were divided on following groups: favorable outcome (no signs of ventricular remodeling or regress acute myocardial expansion) and unfavorable development of remodeling (progressive course of remodeling). The levels of biomarkers (MMP9, NTproBNP, hsCRP) were significantly above in patients with progressive ventricular remodeling (p < 0.05). Prognostic risk-index (K) of an progressive ventricular remodeling in patients after ACS could be formulated as К = 0,009 × MMP9 + 0,00032 × NTproBNP + 0,15 × monocytes + 0,03 × proMMP1 + 0,08 × hsCRP — 5,4. The risk of unfavorable development of the left ventricular remodeling was high if К > - 0,85, in the same time the risk is low if К ≤ - 0,85.

Conclusions

The levels MMP-9, proMMP1, monocytes, hsCRP and NT-proBNP had prognostic significance for evaluation of the high risk of progressive ventricular remodeling in patients after ACS.

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