Laboratory and instrumental parameters associated with the long-term mortality risk in patients after myocardial infarction

Abstract

BACKGROUND: The risk of death remains high in patients who survive 1 year after myocardial infarction (MI).

AIM: To identify the laboratory and instrumental parameters of myocardial remodeling associated with long-term mortality in patients 1 year after MI.

MATERIAL AND METHODS: The study included 184 patients who survived 1 year after MI. Group 1 included living patients who were followed up for 5 years after MI (n = 160). group 2 comprised patients who had died by the 5-year mark (n = 24). Inflammation and myocardial dysfunction biomarkers and echocardiographic parameters reflecting types of left ventricular remodeling, linear dimensions of cardiac cavities, wall thickness, chamber volumes, and systolic ventricular function were retrospectively analyzed. After analyzing the distribution of numerical data, the Student’s t-test or Mann–Whitney U test and χ² test for categorical variables were applied. A logistic regression model was developed. This model was validated and assessed for reliability using the receiver operator characteristics curve, Hosmer–Lemeshow goodness-of-fit test, and bootstrap method.

RESULTS: Patients in group 2 were older (p = 0.007) and more likely to experience ST-segment elevation MI during hospitalization (p < 0.001). One year after the MI, a complex pattern of N-terminal brain natriuretic propeptide level changes was observed, with a decrease in group 1 and an increase in group 2. The end-diastolic volume index (p = 0.014) and left ventricular asynergy size were higher (p = 0.043) and the ejection fraction was lower (p = 0.015) in group 2 than in group 1. The model for predicting 4-year mortality in patients who survived MI during the first year includes parameters such as the left ventricular end-diastolic volume index, N-terminal pro-brain natriuretic peptide level, and presence of concentric left ventricular hypertrophy.

CONCLUSION: In patients who survive 1 year following MI, long-term mortality risk is associated with parameters reflecting left ventricular remodeling and heart failure development.

Keywords

myocardial infarction / long-term mortality risk / left ventricular remodeling / NT-proBNP

References

[1] Kruchkov DV, Artamonova GV. Long-term survival after myocardial infarction. Kardiologiia. 2016;56(6):32–35. (In Russ.) doi: 10.18565/cardio.2016.6.32-35

[2] Крючков Д.В., Артамонова Г.В. Отдалённая выживаемость после инфаркта миокарда // Кардиология. 2016. Т. 56, № 6. С. 32–35. doi: 10.18565/cardio.2016.6.32-35

[3] Qing Ye, Jie Zhang, Likun Ma. Predictors of all-cause 1-year mortality in myocardial infarction patients. Medicine (Baltimore). 2020;99(29):e21288. doi: 10.1097/MD.0000000000021288

[4] Qing Ye, Jie Zhang, Likun Ma. Predictors of all-cause 1-year mortality in myocardial infarction patients // Medicine (Baltimore). 2020. Vol. 99, N. 29. Р. e21288. doi: 10.1097/MD.0000000000021288

[5] Tolpygina SN, Martsevich SYu. Cardiac risk stratification in stable coronary artery disease. Clinician. 2020;14(1–2):24–33. (In Russ.) doi: 10.17650/1818-8338-2020-14-1-2-24-33

[6] Толпыгина С.Н., Марцевич С.Ю. Стратификация риска сердечно-сосудистых осложнений при стабильной ишемической болезни сердца // Клиницист. 2020. Т. 14, № 1–2. С. 24–33. doi: 10.17650/1818-8338-2020-14-1-2-24-33

[7] Steg PG, Greenlaw N, Tardif JC, Tendera M, Ford I, Kääb S, Abergel H, Fox KM, Ferrari R. Women and men with stable coronary artery disease have similar clinical outcomes: Insights from the international prospective CLARIFY registry. Eur Heart J. 2012;33(22):2831–2840. doi: 10.1093/eurheartj/ehs289

[8] Steg P.G., Greenlaw N., Tardif J.C., et al. Women and men with stable coronary artery disease have similar clinical outcomes: Insights from the international prospective CLARIFY registry // Eur Heart J. 2012. Vol. 33, N. 22. Р. 2831–2840. doi: 10.1093/eurheartj/ehs289

[9] Polyakov DS, Fomin IV, Belenkov YuN, Mareev VYu, Ageev FT, Artemjeva EG, Badin YuV, Bakulina EV, Vinogradova NG, Galyavich AS, Ionova TS, Kamalov GM, Kechedzhieva SG, Koziolova NA, Malenkova VYu, Malchikova SV, Mareev YuV, Smirnova EA, Tarlovskaya EI, Shcherbinina EV, Yakushin SS. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4–14. (In Russ.) doi: 10.18087/cardio.2021.4.n1628

[10] Поляков Д.С., Фомин И.В., Беленков Ю.Н., и др. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХА-ХСН // Кардиология. 2021. Т. 61, № 4. С. 4–14. doi: 10.18087/cardio.2021.4.n1628

[11] 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) doi: 10.15829/1560-4071-2020-4083

[12] Хроническая сердечная недостаточность. Клинические рекомендации 2020 // Российский кардиологический журнал. 2020. Т. 25, № 11. С. 4083. doi: 10.15829/1560-4071-2020-4083

[13] Linthout SV, Tschöpe C. Inflammation — cause or consequence of heart failure or both? Curr Heart Fail Rep. 2017;14(4):251–265. doi: 10.1007/s11897-017-0337-9

[14] Linthout S.V., Tschöpe C. Inflammation — cause or consequence of heart failure or both? // Curr Heart Fail Rep. 2017. Vol. 14, N. 4. Р. 251–265. doi: 10.1007/s11897-017-0337-9

[15] Putyatina AN, Kim LB. Cardiac extracellular matrix and postinfarction reparative fibrosis (Part 1). Vestnik of Northern (Arctic) Federal University. Series: “Medical and biological sciences”. 2016:4:54–66. (In Russ.) doi: 10.17238/issn2308-3174.2016.4.54

[16] Путятина А.Н., Ким Л.Б. Внеклеточный матрикс сердца и постинфарктный репаративный фиброз (часть 1) // Вестник Северного (Арктического) федерального университета. Серия: Медико-биологические науки. 2016. Т. 4. С. 54–66. doi: 10.17238/issn2308-3174.2016.4.54

[17] Musikhina NA, Petelina TI, Kostousova AI, Gapon LI, Gorbatenko EA, Bessonov IS. Biomarkers of inflammation in patients with myocardial infarction and heart failure with preserved and mid-range ejection fraction: 5-year prospective follow-up. Russian Journal of Cardiology. 2020;25(12):3726. (In Russ.) doi: 10.15829/1560-4071-2020-3726

[18] Мусихина Н.А., Петелина Т.И., Костоусова А.И., и др. Биомаркёры воспаления у перенёсших инфаркт миокарда пациентов с сохранённой и незначительно сниженной фракцией выброса левого желудочка, пятилетнее проспективное наблюдение // Российский кардиологический журнал. 2020. Т. 25, № 12. С. 3726. doi: 10.15829/1560-4071-2020-3726

[19] Omran F, Kyrou I, Osman F, Lim VG, Randeva HS, Chatha K. Cardiovascular biomarkers: Lessons of the past and prospects for the future. Int J Mol Sci. 2022;23(10):5680. doi: 10.3390/ijms23105680

[20] Omran F., Kyrou I., Osman F., et al. Cardiovascular biomarkers: Lessons of the past and prospects for the future // Int J Mol Sci. 2022. Vol. 23, N. 10. Р. 5680. doi: 10.3390/ijms23105680

[21] Pereira-da-Silva T, Napoleao P, Pinheiro T, Selas M, Silva F, Ferreira RC, Carmo MM. Inflammation is associated with the presence and severity of chronic coronary syndrome through soluble CD40 ligand. Am J Cardiovasc Dis. 2020;10:329–339a. PMID: 33224580

[22] Pereira-da-Silva T., Napoleao P., Pinheiro T., et al. Inflammation is associated with the presence and severity of chronic coronary syndrome through soluble CD40 ligand // Am J Cardiovasc Dis. 2020. Vol. 10. P. 329–339a.

[23] Napoleão P, Cabral LBP, Selas M, Freixo C, Monteiro MC, Criado MB, Costa MC, Enguita FJ, Viegas-Crespo AM, Saldanha C, Carmo MM, Ferreira RC, Pinheiro T. Stratification of ST-elevation myocardial infarction patients based on soluble CD40L longitudinal changes. Transl Res. 2016;176:95–104. doi: 10.1016/j.trsl.2016.04.005

[24] Napoleão P., Cabral L.B.P., Selas M., et al. Stratification of ST-elevation myocardial infarction patients based on soluble CD40L longitudinal changes // Translational Research. 2016. Vol. 176. P. 95–104. doi: 10.1016/j.trsl.2016.04.005

[25] Barsukov AV, Zobnina MP, Talantseva MS. Left ventricular hypertrophy and outcomes: A five-year retrospective analysis of patients with essential hypertension. Arterial Hypertension. 2012;18(5):385–397. (In Russ.) EDN: PGCPVF

[26] Барсуков А.В., Зобнина М.П., Таланцева М.С. Гипертрофия левого желудочка и прогноз: данные пятилетнего ретроспективного наблюдения за пациентами с эссенциальной гипертензией // Артериальная гипертензия. 2012. Т. 18, № 5. С. 385–397. EDN: PGCPVF

[27] Kalyuzhin VV, Teplyakov AT, Solovtsov MA, Kalyuzhina EV, Bespalova ID, Terentyeva NN. Remodeling of the left ventricle: one or several scenarios? Bulletin of Siberian Medicine. 2016;15(4):120–139. (In Russ.) doi: 10.20538/1682-0363-2016-4-120-139

[28] Калюжин В.В., Тепляков А.Т., Соловцов М.А., и др. Ремоделирование левого желудочка: один или несколько сценариев? // Бюллетень сибирской медицины. 2016. Т. 15, № 4. С. 120–139. doi: 10.20538/1682-0363-2016-4-120-139

[29] Movahed MR, Ramaraj R, Manrique C, Hashemzadeh M. Left ventricular hypertrophy is independently associated with all-cause mortality. Am J Cardiovasc Dis. 2022;15;12(1):38–41. PMID: 35291507

[30] Movahed M.R., Ramaraj R., Manrique C., Hashemzadeh M. Left ventricular hypertrophy is independently associated with all-cause mortality // Am J Cardiovasc Dis. 2022. Vol. 15, N. 12 (1). Р. 38–41. PMID: 35291507

[31] Verma A, Meris A, Skali H, Ghali JK, Arnold JMO, Bourgoun M, Velazquez EJ, McMurray JJV, Kober L, Pfeffer MA, Califf RM, Solomon SD. Prognostic implications of left ventricular mass and geometry following myocardial infarction: The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging. 2008;1(5):582–591. doi: 10.1016/j.jcmg.2008.05.012

[32] Verma A., Meris A., Skali H., et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic study // JACC Cardiovasc Imaging. 2008. Vol. 1, N. 5. P. 582–591. doi: 10.1016/j.jcmg.2008.05.012

[33] Nurmukhamedova EK, Shamukhamedova NS, Aripkhodzhaeva FZ. The role of neurohumoral factors in the prognosis of patients who have suffered myocardial infarction. Molodoi uchenyi. 2018;(13):83–87. (In Russ.)

[34] Нурмухамедова Е.К., Шамухамедова Н.Ш., Арипходжаева Ф.З. Роль нейрогуморальных факторов в прогнозе больных, перенёсших инфаркт миокарда // Молодой учёный. 2018. № 13. С. 83–87.

RIGHTS & PERMISSIONS

Eco-Vector