Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Cardiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Bras. Cardiol. 119 (6) • Dec 2022 • https://doi.org/10.36660/abc.20220061 copy

The Relationship between Extracellular Volume Compartments and Matrix Metalloproteinases-2 in Left Ventricular Remodeling after Myocardial Infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Matrix metalloproteinases (MMPs) can affect myocardial extracellular volume (ECV) and its compartments, and this can provide more detailed information about the mechanism of adverse left ventricular (LV) remodeling (AR) after acute myocardial infarction (MI).

Objectives:

To investigate the role of changes (Δ) in ECV compartments (matrix volume (MVi) and cell volume (CVi)) in the development of AR after MI, and their relationship with MMP-2 expressions.

Methods:

Ninety-two first MI patients who underwent 3 Tesla cardiovascular magnetic resonance imaging performed 2 weeks (baseline) and 6 months post-MI. We measured T1 mapping with MOLLI sequences. ECV was performed post-gadolinium enhancement. ECV and LV mass were used to calculate MVi and CVi. AR was defined as an increase of ≥ 12% in LV end-diastolic volume in 6 months. MMPs were measured using a bead-based multiplex immunoassay system at first day (baseline) and 2 weeks post-MI. P <0.05 was accepted as statistically significant.

Results:

Mean ECV and mean MVi baseline levels were higher in AR group compared to without AR group (42.9±6.4 vs 39.3±8.2%, p= 0.037; 65.2±13.7 vs 56.7±14.7 mL/m², p=0.010; respectively). CVi levels was similar between groups. A positive correlation was found between baseline levels of MMP-2 and baseline levels of ECV (r=0.535, p<0.001) and MVi (r=0.549, p<0.001). Increased ΔMVi levels was independently predictor of AR (OR=1.03, p=0.010). ΔMVi had superior diagnostic performance compared to ΔECV in predicting AR (ΔAUC: 0.215±0.07, p<0.001).

Conclusion:

High MVi levels are associated with AR, and ΔMVi was independently predictor of AR. This may be associated with MMP-2 release due to increased inflammatory response.

Keywords:
Myocardial Infarction/metabolism; Ventricular Remodeling; Myofibroblasts/cytology; Matrix Metaloproteinase; TI Mapping/cytology

Variables			Total population n=92	Adverse remodeling		p
Variables			Total population n=92	Yes n=30	No n=62	p
Demographic findings
	Age, years		54.1±9.0	53.4±8.5	54.4±9.3	0.623
	Male gender, n(%)		83(90.2)	25(83.3)	58(93.5)	0.241
	BMI, kg/m²		26.7±4.3	27.0±3.7	26.5±4.6	0.704
	BSA, m²		1.9±0.2	1.9±0.2	1.9±0.2	0.997
	Hypertension, n (%)		40(43.5)	12(40.0)	28(45.2)	0.661
	Diabetes, n (%)		27(29.3)	9(30.0)	18(29.0)	0.999
	Dyslipidemia, n (%)		24(26.1)	10(33.3)	14(22.6)	0.315
	Smoking, n (%)		46(50.0)	19(63.3)	27(43.5)	0.113
Clinical findings
	Heart rate, bpm		76.9±16.8	75.2±12.6	77.8±18.7	0.509
	SBP, mm Hg		123±15.5	124.1±14.7	122.4±16.1	0.657
	DBP, mm Hg		77.2±12.2	77.8±11.2	77.0±12.8	0.785
	Symptom-to-balloon time, mins		312.2±68.4	304.6±67.2	317.4±69.8	0.535
	Door-to-balloon time, mins		28.1±8.8	27.2±8.4	29.5±9.0	0.358
	IRA, n(%)
		LAD	67(72.8)	22(73.3)	45(72.6)	0.999
		Cx	25(27.2)	8(26.7)	17(27.4)	0.999
	Grace score		128.5±30.4	131.1±24.0	127.3±33.2	0.529
	Pre-PCI TIMI flow, n(%)
		0	54(58.7)	18(60.0)	36(58.1)	0.848
		1	15(16.3)	5(16.7)	10(16.1)
		2	2(17.5)	5(16.7)	12(19.4)
		3	6(6.5)	2(6.7)	4(6.5)
	Post-PCI TIMI flow >2, n(%)		90(97.8)	29(96.7)	61(98.4)	0.999
Laboratory findings
	cTn-I, ng/L		46.4(37.7-57.8)	56.5(50.4-60.0)	41.7(35.5-48.0)	<0.001
	Hemoglobin, g/dL		13.8±1.5	14.0±1.8	13.6±1.4	0.375
	WBC, x10⁹/L		12.3±3.3	12.4±3.2	12.2±3.4	0.829
	Lymphocytes, x10⁹/L		2.3±0.8	2.2±0.8	2.4±0.8	0.149
	Neutrophils, x10⁹/L		8.4±2.1	8.8±1.9	8.2±2.2	0.190
	Monocyte, x10⁹/L		0.7±0.2	0.8±0.2	0.7±0.2	0.884
	Platelets, x10⁹/L		301.7±60.7	318.6±54.0	293.5±62.5	0.062
	Glucose, mg/dL		112(75-140)	114(100-149)	107(83-139)	0.390
	Total cholesterol, mg/dL		197(160-220)	191(155-211)	200(164-240)	0.264
	LDL, mg/dL		132(100-157)	119(101-144)	136(100-170)	0.261
	HDL, mg/dL		41.3±9.2	41.7±9.5	41.1±9.1	0.781
	C-reactive protein, mg/L		24.2(13-31.3)	28.0(16-41.2)	18.3(11.7-26.3)	0.024
Discharge therapy, n(%)
	ACE/ARB		90(97.8)	30(100.0)	60(96.8)	0.816
	Beta blockers		90(97.8)	29(96.7)	61(98.4)	0.999
	Statins		91(98.9)	30(100.0)	61(98.4)	0.999

Variables			Total population n=92	Adverse remodeling		p
Variables			Total population n=92	Yes n=30	No n=62	p
Second weeks
	LVEF, %		46.8±9.6	46.5±9.6	47.0±9.6	0.818
	LVEDV, mL		155(130.1-172.5)	153(135-176.7)	157.6(129-170)	0.723
	LVESV, mL		83.4(60.1-112.5)	93.5(70.7-128)	78.3(60-102)	0.207
	LVMi, g/m²		144(130-165)	147(133-176)	143(128-162)	0.257
	Infarct size, % of LV		15(11-22)	18(12-21)	15(10-21)	0.407
	Native T1, ms
		Pre-contrast	1411.0±148.8	1421.2±162.8	1406.5±142.8	0.692
		Post-contrast	490.8±88.2	493.5±90.7	489.5±87.7	0.837
	ECV, %		40.1±7.4	42.9±6.4	39.3±8.2	0.037
	MVi, mL/m²		59.5±14.9	65.2±13.7	56.7±14.7	0.010
	CVi, mL/m²		88.0±15.0	86.3±13.6	88.9±15.6	0.447
Sixth months
	LVEF, %		47.7±9.7	42.9±10.3	50.0±8.5	0.001
	LVEDV, mL		155.4(130-180.9)	180.7(159-227)	140(125.6-162.3)	<0.001
	LVESV, mL		79(59.7-116.1)	115.6(80-164)	68.9(54.4-90.7)	<0.001
	LVMi, g/m²		126(116-144)	138(122-166)	123(112-137)	0.002
	Infarct size, % of LV		12(8-16)	15(10-18)	11(7-15)	0.035
	Native T1, ms
		Pre-contrast	1309.4±135.7	1325.2±117.0	1302.4±136.7	0.490
		Post-contrast	455.3±82.1	438.7±69.4	463.3±86.9	0.179
	ECV, %		45.8±6.2	49.7±6.1	44.0±5.4	<0.001
	MVi, mL/m²		60.5±15.2	70.7±12.1	55.6±11.8	<0.001
	CVi, mL/m²		70.6±11.0	70.9±12.2	70.4±10.4	0.851

Variables	Adverse remodeling	Second weeks	Sixth months	p¹ 1 p Second weeks vs sixth months within remodeling groups.	p² 2 p Comparison of the changes in follow-up (Adverse remodeling groups: No vs. Yes). CVi: cell volume index; ECV: extracellular volume, LVMi: left ventricular mass index; MVi: matrix volume index.
LVMi, g/m²	No	143(128-162)	123(112-137)	<0.001	0.011
LVMi, g/m²	Yes	147(133-176)	138(122-166)	<0.001	0.011
Infarct size, % of LV	No	15(10-21)	11(7-15)	<0.001	0.715
Infarct size, % of LV	Yes	18(12-21)	15(10-18)	<0.001	0.715
Native T1 infarct, ms	No	1406.5±142.8	1302.4±136.7	<0.001	0.378
Native T1 infarct, ms	Yes	1421.2±162.8	1320.2±117	0.005	0.378
ECV, %	No	39.3±8.2	44.0±5.4	<0.001	0.027
ECV, %	Yes	42.9±6.4	49.7±6.1	<0.001	0.027
MVi, mL/m²	No	56.7±14.7	55.6±11.8	0.480	0.007
MVi, mL/m²	Yes	65.2±13.7	70.7±12.1	<0.001	0.007
CVi, mL/m²	No	88.9±15.6	70.4±10.4	<0.001	0.164
CVi, mL/m²	Yes	86.3±13.6	70.9±12.2	<0.001	0.164

Variables		Univariable			Multivariable
Variables		OR	95% CI	p	OR	95% CI	p
Model I
	cTn-I	1.05	1.01-1.09	0.011	1.28	1.05-1.55	0.013
	C-reactive protein	1.07	1.01-1.12	0.017	1.15	1.01-1.32	0.044
	ΔLVMi	1.28	1.12-1.48	0.010	1.36	1.14-1.78	0.012
	ΔInfarct size	1.02	0.98-1.06	0.249	-	-	-
	ΔNative T1 infarct	1.01	0.97-1.06	0.154	-	-	-
	ΔECV	1.04	1.01-1.08	0.025	1.05	1.02-1.09	0.041
					Nagelkerke R²=0.537, p<0.001
Model II
	cTn-I	1.05	1.01-1.09	0.011	1.32	1.12-1.56	0.014
	C-reactive protein	1.07	1.01-1.12	0.017	1.15	1.03-1.30	0.020
	ΔInfarct size	1.02	0.98-1.06	0.249	-	-	-
	ΔNative T1 infarct	1.01	0.97-1.06	0.154	-	-	-
	ΔMVi	1.06	1.01-1.11	0.004	1.03	1.01-1.06	0.010
	ΔCVi	0.97	0.95-0.99	0.089	-	-	-
					Nagelkerke R²=0.615, p<0.001

Variables		First day post-MI MMP-2		2 weeks post-MI MMP-2
Variables		r	p	r	p
2 weeks
	LVMi	0.301	0.047	0.089	0.551
	Infarct size	0.024	0.878	0.221	0.144
	Native T1 infarct	0.135	0.367	0.166	0.263
	ECV (%)	0.535	<0.001	0.355	0.014
	MVi	0.549	<0.001	0.325	0.029
	CVi	0.031	0.837	0.143	0.338

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS