Artmış Galektin-3 Düzeyleri, ST Elevasyonlu Miyokart Enfarktüsünü Takiben Gelişen Ventriküler Aritmik Olayları Öngörür

Year 2020, Volume: 73 Issue: 2, 124 - 129, 21.07.2020

İsmail Bolat

Abstract

Amaç: Sol ventrikül ejeksiyon fraksiyonu (EF) (LVEF) >%35 ve tek damar tıkanıklığı olan ve primer perkütan koroner girişim (pPCI) ile tedavi edilen ST segment elevasyonlu miyokart enfarktüsü (MI) (STEMI) hastalarında, Galektin-3 (Gal-3) düzeyleri ile mikrovolt T dalga alternans (MTWA) ve sık prematüre ventriküler kompleksler (PVC) arasındaki ilişkiyi belirlemeyi amaçladık.

Gereç ve Yöntem: Bu kesitsel çalışmaya toplam 81 hasta dahil edildi. Başvuru anında tüm has talardan Gal-3 düzeyleri için kan örnekleri alındı. Hastalar düşük ve yüksek Gal-3 (sırasıyla ≤ ve > 1,93 ng/dL) gruplarına ayrıldı. Düşük Gal-3 ve yüksek Gal-3 grupları hem MTWA hem de PVC pozitifliği açısından karşılaştırılmış ve Gal-3 düzeyleri ile ilişkisi incelenmiştir.

Bulgular: Düşük Gal-3 grubu ile karşılaştırıldığında, yüksek Gal-3 hastalarında sol atriyal hacim (LAV) daha yüksekti (55,7±18,0’a karşı 40,6±13,7 mL, p<0,001). Çok değişkenli analizler yaş, LAV ve Gal-3 düzeylerinin PVC pozitifliğinin anlamlı bağımsız prediktörleri olduğunu (sırasıyla p=0,005, p=0,04, p=0,002); ve Gal-3’ün, MTWA pozitifliğinin anlamlı bir bağımsız prediktörü olduğunu gösterdi (p=0,002).

Sonuç: Gal-3, PVC ve MTWA pozitifliği ile ilişkiliydi ve LVEF >%35 olan tek damarlı STE-MI hastalarında aritmik olayların bir prediktörü idi.

Keywords

Galectin-3, Mikrovolt T Dalgası Değişim Testi, Ventriküler Erken Atımlar, ST-yükselmeli Miyokart Enfarktüsü

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

Increased Galectin-3 Levels Predicts Ventricular Arrhythmic Events Following ST-elevation Myocardial İnfarction

Abstract

Objectives: We aimed to determine the association between Galectin-3 (Gal-3) levels and microvolt T-wave alternans (MTWA) and frequent premature ventricular complexes (PVCs) in single-vessel patients with left ventricular ejection fraction (EF) (LVEF) >35%, who presented with STelevated myocardial infarction (MI) (STEMI) and were treated with primary percutane-ous coronary intervention (pPCI).

Materials and Methods: A total of 81 patients were included in this cross-sectional study. Blood samples for Gal-3 levels were obtained from all patients at the time of admission. The patients were separated into low and high Gal-3 (≤ and >1.93 ng/dL, respectively) groups. Low-Gal-3 and high-Gal-3 groups were compared with respect to both MTWA and PVC positivity and their association with Gal-3 levels were examined.

Results: When compared to the low-Gal-3 group, left atrial volume (LAV) was higher in the high-Gal-3 patients (55.7±18.0 vs 40.6±13.7 mL,
p<0.001). Multivariate analyses revealed that age, LAV and Gal-3 levels were significant independent predictors of PVC positivity (p=0.005, p=0.04, p=0.002, respectively); and Gal-3 was a significant independent predictor of MTWA positivity (p=0.002).

Conclusion: Gal-3 was associated with PVC and MTWA positivity, and was a predictor of arrhythmic events in single-vessel STEMI patients with LVEF >35%.

Keywords

Galectin-3, Microvolt T-wave Alternans, Premature Ventricular Complexes, ST-elevated Myocardial Infarction

Ethical Statement

This study was approved by Muğla Sıtkı Koçman University Rectorate Building, Dean’s Office of Faculty of Medicine Clinical Researches Ethics Committee (no: 72855364-050.01.04-E.24474).

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. McManus DD, Gore J, Yarzebski J, et al. Recent trensds in the incidence,treatment,and outcomes of patients with STEMI and NSTEMI.Am J Med. 2011;124:40-47.
• 2. Jerberg T, Johanson P, Held C, et al. Association between adoption of evidence-based treatment and survival for patients with St-elevation myocardial infarction. JAMA. 2011;305:1677-1684.
• 3. Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodelling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002;106:2351-2357.
• 4. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015;36:2793-2867.
• 5. Stecker EC, Vickers C, Waltz J, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: twoyear findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006;47:1161-1166.
• 6. Chow T, Kereiakes DJ, Bartone C, et al. Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2006;47:1820-1827.
• 7. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation. 1993;87:312-322.
• 8. Dumic J, Dabelic S, Flogel M. Galectin-3:an open-ended story. Biochim Biophys Acta. 2006;1760:616-635.
• 9. Pusuroglu H, Akgul O, Erturk M, et al. Assessment of relationship between galectin-3 and ambulatory ECG-based microvolt T-wave alternans in sustained systodiastolic hypertension patients. Blood Press Monit. 2016;21:265-270.
• 10. Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with STsegment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-177.
• 11. Szadkowska I, Wlazel RN, Migala M, et al. The association between galectin-3 and clinical parameters in patients with first acute myocardial infarction treated with primary percutaneous coronary angioplasty. Cardiol J. 2013;20,6:577-582.
• 12. Cohn JN, Ferrari R, Sharpe N. Cardiac remodelling-concepts and clinical implications:a consensus paper from an international forum on cardiac remodelling. Behalf of an International Forum on Cardiac Remodelling. J Am Coll Cardiol. 2000;35:569-582.
• 13. Altara R, Manca M, Sabra R, et al. Temporal cardiac remodelling postmyocardial infarction. Dynamics and prognostic implications in personalized medicine. Heart Fail Rev. 2015:21;25-47.
• 14. Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation. 2005:111;2837-2849.
• 15. Bello D, Fieno DS, Kim RJ, et al. Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol. 2005:45;1104-1108.
• 16. Wu TJ, Ong JJ, Hwang C, et al. Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry. J Am Coll Cardiol. 1998:32;187-196.
• 17. Bogun FM, Desjardins B, Good E, et al. Delayed-enhanced magnetic resonance imaging in nonischemiccardiomypotathy: utility for identifying the ventricular arrhythmia substrate. J Am Coll Cardiol. 2009:53;1138-1145.
• 18. Schmidt A, Azevedo CF, Cheng A, et al. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmias susceptibility in patients with left ventricular dysfunction. 2007:115;2006- 2014.
• 19. Perez-David E, Arenal A, Rubio-Guivernau JL, et al. Noninvasive identification of ventricular tachycardia-related conduction channel using contrast-enhanced magnetic resonance imaging in patients with chronic myocardial infarction:comparison of signal intensity scar mapping and endocardial voltage mapping. J Am Coll Cardiol. 2011:57;184-194.
• 20. Disertori M, Rigoni M, Pace N, et al. Myocardial fibrosis assessment by LGE is a powerful predictor of ventricular tachyarrhythmias is ischemic and nonischemic LV dysfunction:a meta-analysis. JACC Cardiovascular Imaging. 2016:9;1056-1058.
• 21. Halliday BP, Gulati A, Ali A, et al. Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction. Circulation. 2017:135;2106-2115.
• 22. Rosenbaum DS, Jackson LE, Smith JM, et al. Electrical alternans and vulnerability to ventricular arrhythmias. N Eng J Med. 1994;330:235-241.
• 23. Hohnloser SH, Ikeda T, Bloomfield DM, et al.T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation. Lancet. 2003:362;125-126.
• 24. Nieminen T, Lehtimäki T, Viik J, et al. T wave alternans predicts mortality in a population undergoing a clinically indicated exercise test. Eur Heart J. 2007:28;2332-2337.
• 25. Bogun F, Crawford T, Chalfoun N, et al. Relationship of frequent postinfarctionprematüre ventricular complexes to the reentry circuit of scar-related ventricular tachycardia. Heart Rhythm. 2008:3;367-374.
• 26. Sharma UC, Pokharel S, van Brakel TJ, et al. Galectin-3 marks activated macrophages in failure-prone hypertrophied hearts and contributes to cardiac dysfunction. Circulation. 2004;110:3121-3128.
• 27. Liu YH, D’Ambrosio M, Liao TD, et al. N-acetyl-aspartyl-lysyl-proline prevents cardiac remodelling and dysfunction induced by galectin-3,a mammalian adhesion/growth-regulatory lectin. Am J Physiol Heart Circ Physiol. 2009;296:H404-H412.
• 28. Lok DJ, van Der Meer P, de la Porte PW, et al. Prognostic value of galectin-3, a novel marker of fibrosis,in patients with chronic heart failure:data from the DEAL-Hf study.Clin Res Cardiol. 2010;99:323-328.
• 29. de Boer RA, Lok DJ, Jaarsma T, et al. Predictive value of plasma galectin-3 levels in heart failure with reduced and preserved ejection. Ann Med. 2011;43:60-68.
• 30. de Boer RA, van Velduisen DJ, Gansevoort RT, et al. The fibrosis marker galectin-3 and outcome in the general population. J Intern Med. 2012;272:55-64.
• 31. Pusuroglu H, Somuncu U, Bolat I, et al. Galectin-3 is associated with coronary plaque burden and obstructive sleep apnoea syndrome severity. Kardiol Pol. 2017;75:351-359.
• 32. Fashanu OE, Norby FL, Aguilar D, et al. Galectin-3 and incidence of atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2017;192:19-25.
• 33. Perea RJ, Morales-Ruiz M, Ortiz-Perez JT, et al. Utility of galectin-3 in predicting post-infarct remodelling after acute myocardial infarction based on extracellular volume fraction mapping. Int J Cardiol. 2016;223:458-464.
• 34. Weir RA, Petrie CJ, Murphy CA, et al. Galectin-3 and cardiac function in survivors of acute myocardial infarction. Cir Heart Fail. 2013;6:492-498.
• 35. Van Der Velde AR, Lexis CP, Meijers WC, et al. Galectin-3 and sST2 in prediction of left ventricular ejection fraction after myocardial infarction. Clin Chim Acta. 2016;452:50-57.
• 36. Di Tano G, Ceretta G, De Maria R, et al. Galectin-3 predicts left ventricular remodelling after anterior-wall myocardial infarction treated by primary percutaneous coronary intervention. Heart. 2017;103:71-77.
• 37. Di Tano G, Caretta G, De Maria R, et al. Galectin-3 and outcomes after anterior-wall myocardial infarction treated by primary percutaneous coronary intervention. Biomark Med. 2018;12:21-26.