The extracellular matrix degradation markers as predictors of left ventricular systolic dysfunction among patients with STEMI

Abstract

The purpose of the study. To determine predictor value of the extracellular matrix degradation markers relative to the occurrence of left ventricular systolic dysfunction among patients with STEMI determined. Materials and methods. The results of the study are based on data obtained from a comprehensive survey of 162 patients with STEMI. The first group consisted of 145 patients with STEMI and left ventricular ejection fraction > 45% (median age – 59 (52–64) years); the second group consisted of 17 patients with STEMI and left ventricular ejection fraction < 45% (median age 61 (55–63) years). All persons were comparable in age, social status, and gender. The sample of patients was carried out in the period from 2015 to January 2018 on the basis of the MI «Regional medical center of cardiovascular diseases» of the Zaporizhzhia regional Council. Results. Significantly, the level of 5816,3 (5487,7–6538,6) PG/ml of matrix metalloproteinase-9 was higher in the left ventricular ejection fraction group < 45% compared to 5129,6 (3984,6–5975,8) PG/ml in the left ventricular ejection fraction group > 45%, (p < 0,05). The level of tissue inhibitor of matrix metalloproteinase-2 among patients with left ventricular ejection fraction < 45% was 524,8 (484,6–648,7) PG/ml and was considerably higher compared to 459,7 (368,3–549,2) PG/ml in the left ventricular ejection fraction group > 45%, (p < 0,05). The largest area under the ROC curve (AUC = 0,694, 95% CI 0,617 to 0,764) among the analyzed markers of extracellular matrix degradation was tissue inhibitor of matrix metalloproteinase-2. At the distribution point > 483,7 PG/ml, the sensitivity was 76,47% and the specificity was 62,07% for left ventricular systolic dysfunction among patients with STEMI. The calculated relative risk was for matrix metalloproteinase-9 > 5247,9 PG/ml for the development of left ventricular systolic dysfunction was 7,139, 95% CI 1,686–30,218. For the level of tissue inhibitor of matrix metalloproteinase-2 > 483,7 PG/ml, the relative risk was 4,271, 95% CI 1,455–12,536 for the development of left ventricular systolic dysfunction. Conclusions. Patients having STEMI with left ventricular ejection fraction < 45% had essentially higher levels of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-2. At matrix metalloproteinase-9 > 5247.9 PG/ml level relative risk of the developing left ventricular systolic dysfunction in patients with STEMI increases by 7.139 times. Keywords: acute myocardial infarction, matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-2, left ventricular systolic dysfunction.