Neopterin predicts left ventricular remodeling in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Introduction
The development of left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI) is relatively common and associated with impaired patient outcome [1]. Early diagnosis of LVR in STEMI patients could lead to more efficient patient management and improved prognosis [2]. Inflammation, in general, and macrophage activation, in particular, may play a major role in LVR. Neopterin has been shown to be elevated in patients with dilated cardiomyopathy [3], [4] and it has also been implicated as a predictor of left ventricular dysfunction in patients with chronic stable angina pectoris [5] and acute myocardial infarction [6]. Experimental studies indicate that proinflammatory cytokines are associated to molecular, clinical, and physiological aspects of LVR [7]. The relationship, however, between increased neopterin levels and LVR has not been assessed systematically in patients with STEMI. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in STEMI patients.
Section snippets
Patients
One hundred and fifty patients with first STEMI were admitted into a tertiary care hospital where they received percutaneous coronary intervention (PCI) treatment within 6 h of symptom. The diagnosis of STEMI was established in all patients by the presence of: typical rise and gradual fall (troponin) or more rapid rise and fall (creatine kinase MB) of biochemical markers of myocardial necrosis with at least one of the following: (a) ischemic symptoms; (b) development of pathological Q waves on
Results
Baseline clinical and angiographic characteristic of the entire patient cohort are displayed in Table 1. All patients were treated with primary PCI, and the results were considered successful in 98% of the patients. Twenty-one patients (19%) showed LVR and 87 (81%) had no LVR. Clinical and angiographic variables in patients with and without LVR are shown in Table 2. There were no statistical differences in baseline characteristics, with the exception of neopterin levels (7.45 ± 1.04 vs 5.19 ± 1.39
Discussion
The main and original finding of our study is that neopterin levels on admission were associated with LVR at 12-month follow-up in patients admitted to hospital with first STEMI. LVR was observed in 19% of patients despite of successful primary PCI reperfusion strategies and the systematic use of secondary prevention pharmacologic therapies. This rate of LVR is similar to that reported in previous studies [17] and suggests that factors other than infarct size and infarct-related artery patency
Acknowledgement
The authors thank specially Dr. Alejandro Jimenez-Sosa for assistance with statistical analysis.
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Neopterin levels are independently associated with cardiac remodeling in patients with chronic heart failure
2013, Clinical BiochemistryCitation Excerpt :Neopterin, an aromatic pteridine mainly synthesized by activated monocytes, is a marker of inflammation, immune system activation and an active participant in cardiovascular diseases [9]. Its assessment is proposed as potential tool useful for risk stratification of patients with AMI [10], for prediction of 1-year LV remodeling in patients with ST-segment elevation AMI [11], and as independent predictor of HF hospitalization after an acute coronary syndrome [12]. High serum neopterin levels were found in CHF patients with elevated NYHA class [13] and were associated with high rates of cardiac events in HF patients [14].
Usefulness of circulating biomarkers for the prediction of left ventricular remodeling after myocardial infarction
2012, American Journal of CardiologyCitation Excerpt :We included studies that reported LV volumes or LV diameters as indicators of LV remodeling. Because variability of the data reported (morphologic and biological variables on their original continuous scales or dichotomized into 2 groups) precluded a formal meta-analysis, relations between biomarkers and LV remodeling are presented in Table 1 as positive if a high level of the biomarker was significantly associated (p <0.05) with increased LV remodeling, negative if a low level of the biomarker was significantly associated (p <0.05) with increased LV remodeling, and none in the absence of any significant association.1–59 To visualize the association of a given biomarker with LV remodeling, data were grouped by biomarker; thus, publications that assessed >1 biomarker appear >1 time in Table 1.
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