Použití matrixové metalopeptidázy-9 (MMP-9) u pacientů s akutním infarktem myokardu s elevacemi úseku ST (STEMI) po perkutánní koronární intervenci (PCI) jako prognostického indikátoru má mnoho mezer a lékařská komunita s tím má velmi omezené zkušenosti. Cílem studie bylo zhodnotit prognostickou roli MMP-9 u pacientů se STEMI po úspěšné revaskularizaci během 12měsíčního období sledování. Materiál a metoda: Do studie bylo zařazeno 88 pacientů, kteří splnili kritéria pro zařazení a neměli žádná vylučovací kritéria, jimž byl diagnostikován STEMI a podstoupili primární PCI. Mužů bylo 66 (75,0 %), s průměrným věkem 60,84 ± 9,68 roku. Doba sledování činila 12 měsíců. Byl použit složený cílový ukazatel, který zahrnoval výskyt srdečního selhání, které si vyžádalo hospitalizaci, úmrtí z kardiovaskulárních příčin, recidivující infarkt myokardu, akutní cerebrovaskulární příhodu. Koncentrace MMP-9 byla stanovena pomocí ELISA. Výsledky: Kaplanova-Meierova analýza křivek ukázala významnou souvislost mezi zvýšenou MMP-9 a studovaným složeným cílovým ukazatelem, p = 0,0229. Pacienti s koncentracemi MMP-9 > 201,7 ng/ml měli signifi kantně více cílových ukazatelů. Jednorozměrná regresní analýza zjistila, že MMP-9 byla indikována jako nezávislá proměnná pro nepříznivý výsledek s poměrem šancí (OR):
The aim of this review was to analyse the scientific literature data on matrix metallopeptidase 9 and to analyse the available information on its prognostic value as a marker of negative outcome in the short- and long-term prognosis in patients with acute coronary syndrome. Materials and methods. In our study was used a recursive literature search strategy at PubMed. The following criteria for inclusion in the analysis were defined – a prospective study in patients with acute coronary syndrome that had data on the effect of MMP-9 levels on short-term and/or long-term outcomes, including mortality and major adverse сardiovascular events. Review articles, clinical cases, animal studies, and studies with insignificant statistical data were not included in the analysis. The depth of the initial search was set at 15 years with a search for similar articles in citations. We selected 5 studies for meta-analysis. Meta-Essentials 1.5 was used for the analysis. Odds ratio and 95 % confidence interval were calculated using the Haenszel method. The association between MMP-9 levels and short-term and long-term outcomes (mortality and major adverse CV events) was determined. The statistically significant level was defined as P < 0.05. Results. The analysis showed no significant association between the level of MMP-9 and the outcome (OR = 1.39; 95 % CI = 0.25–7.79; P = 0.595; I2 = 78 %). Conclusions. Matrix metallopeptidase 9 is a promising marker for further investigation of its predictive strength of outcome. Despite the opposite results of single studies and no significant association of MMP-9 with outcome further research on this issue is a promising direction.
Aim of our study was to determine the role of the clinical and biochemical markers in predicting the outcomes at one year in patients with STEMI who have undergone primary PCI. Materials and methods: The study included 165 patients admitted with STEMI within 12 hours of the onset of symptoms be¬tween January 2020 and August 2021. All patients underwent primary PCI according to the guidelines, followed by standard examination and treatment at the hospital. Blood samples for biomarker analysis (MMP-9, cTnI) and other routine tests were taken on admission. At six months after the event, all patients underwent clinical follow-up. Patients were contacted either by phone, through family members or their physicians 1 year after the event. Results: The composite endpoint reached 9% of patients at one-year follow-up. ROC analysis of MMP-9 with the one-year com¬posite endpoint showed an AUC=0.711, with 91.7% sensitivity, and 47.4% specificity, 95% CI – 0.604 to 0.802, p=0.0037. ROC analysis of EQ-5D questionnaire with the one-year composite endpoint showed AUC = 0.73, the 95% CI – 0.624 to 0.820, p< 0.0195, with sensitivity 54.5% and specificity 94.7%. A logistic regression model showed a statistical association with the com¬posite endpoint at one year after STEMI in both EQ-5D (OR=0.89, 95% CI: 0.8313- 0.9725, p=0.0079) and MMP-9 (OR=1.0151, 95% CI:1.0001-1.0304, p=0.0481). Conclusions: The level of MMP-9 more than 194 ng/ml and <55 points in EQ-5D predicts major adverse cardiovascular events, in¬cluding cardiovascular mortality and progressive heart failure, as well as other elements of composite endpoints, during a 1-year follow-up in patients with STEMI after primary PCI. Future studies are needed to clarify this result.
The aim of our study was to determine the base levels of Growth Differentiation Factor 15, P-selectin and Galectin-3 in blood plasma in patients with AH and T2DM and to assess their association with the diseases clinical course. Materials and methods. A total of 121 patients were included in our study (60 female and 61 male, mean age 64.7±10.6 years, with AH and/or T2DM). Patients were divided into three groups: 1st group with AH only (51 patient), 2nd group with AH and T2DM (57 patients) and 3rd group with T2DM only (13 patients, control group). GDF-15, Galectin-3 and P-selectin tests were performed using standard enzyme-linked immunosorbent assay kits (ELISA). Results. Compared with AH without T2DM and T2DM only groups, AH with T2DM group had a statistically significant higher level of GDF-15. Grade 3 hypertension group had a significantly lower level of GDF-15 compared with Grade 1&2 hypertension groups. P-selectin mean level was significantly higher in Grade 3 hypertension group GDF-15 compared with Grade 1&2 hypertension groups. We observed weak correlation between Galectin-3 and GDF-15 in blood plasma, which was confirmed by linear regression analysis. Conclusions. A combination of hypertension and type 2 diabetes mellitus revealed a significant increase of GDF-15 levels in compare with patients with only hypertension or type 2 diabetes mellitus, which may be due to a greater response to oxidative stress and low-intensity systemic inflammation. P-selectin mean level was higher in patients with grade 3 hypertension, which reflects a greater platelet activation as a part of the systemic inflammatory response. Galectin-3 mean level was higher in patients with stage 3 hypertension compared with patients with stages 1 and 2 due to possibly more pronounced fibrosis progression.
The purpose of the study was to assess the impact of antihypertensive therapy depending on the classes of drugs on the level of new biomarkers of inflammation: GDF-15, P-selectin and Galectin-3 in blood plasma in patients with hypertension in combination with type 2 diabetes. Material and methods. The study included 121 patients, including 59 women and 62 men aged 40 to 87 years (mean age 64.7±10.6 years). We determined the levels of new biomarkers of inflammation (GDF-15, P-selectin, Galectin-3), and a reference marker of systemic inflammation (high-sensitive CRP (hs-CRP) using standard kits in patients who participated in the study. We also evaluated the effect of different classes of antihypertensive drugs at the level of new biomarkers. Results and discussion. In the group of patients with unattainable target blood pressure, the level of GDF-15 was significantly higher compared with the group of patients whose target level of "office" blood pressure was achieved at the time of inclusion in the study (3286.10±1523.02 and 2326.60±1581.70 ng / ml, p <0.05, respectively). At the same time, plasma levels of P-selectin and Galectin-3 in patients did not differ significantly. After 12 months of hypertension treatment, depending on the achievement of blood pressure control showed that in the group of patients who managed to achieve the target "office" blood pressure, the level of GDF-15 was significantly lower than in the group of patients who did not reach the target level of "office" blood pressure after 12 months of treatment (3129.67±1134.87 and 2543.12±976.54 ng / ml, p <0.05, respectively). Changes of P-selectin, Galectin-3 and hs-CRP were insignificant after 12 months of treatment of hypertension. Baseline plasma levels GDF-15, P-selectin, Galectin-3 and hs-CRP in patients who received or did not receive RAAS blockers had no significant difference. There was a significantly lower baseline level of GDF-15 in the group of patients receiving CCB (2343.42±1280.70 and 3248.29±1178.56 pg / ml, p = 0.05, respectively). Baseline plasma levels of P-selectin, Galectin-3 and hs-CRP in patients who took or did not take CCB did not have a significant difference. According to the meta-analysis of the chances of taking the drugs had a significant effect on the level of GDF-15, while some groups of drugs did not show a significant additional risk of affecting the level of GDF-15 in patients. Conclusion. The dependence of the GDF-15 level on the achievement of the "target" level of blood pressure can be explained by the positive impact on hemodynamics and structural changes in the cardiovascular system due to better control of blood pressure per se. Antihypertensive drugs affect different pathogenetic mechanisms of inflammation in different ways. According to the analysis of the chances, CCB had the greatest impact on reducing the level of GDF-15. None of the classes of antihypertensive drugs had a significant effect on the level of Galectin-3, and there was a tendency to lower levels of hs-CRP in patients taking blockers of RAS and CCB. The level of P-selectin decreased in patients taking β-blockers due to concomitant use of antiplatelets and anticoagulants
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