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Abstract: Background: Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. 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 patients with ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively assessed 108 STEMI patients (age 64±11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96±10h after the onset of symptoms and 12month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI. Results: At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45±1.04 vs 5.19±1.39nmol/L; p <0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928–4.990, p <0.001] to [3.32, CI 95% 1.999–5.532, p <0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84–0.96, p <0.0001) compared to 0.579 for BNP (CI 95% 0.409–0.748) regarding LVR. Conclusions: In STEMI patients undergoing primary PCI, high neopterin levels – but not BNP – predict LVR at 1-year follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the possible association between admission ischemia modified albumin (IMA) levels and ST-segment resolution (STR) in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Materials and Methods: We studied 117 patients with a first STEMI within 6h of the onset of pain. Admission serum IMA concentration was measured using a validated assay. The worst single electrocardiogram lead before and 90min after primary PCI was analyzed, and patients were divided into two groups according to the degree of STR: complete (≥70%) or incomplete (<70%). Results: Of the 117 patients, 70 (60%) had complete STR, and 47 (40%) incomplete STR. Serum IMA concentrations were significantly higher in patients that had incomplete STR (0.383±0.060A.U. vs. 0.297±0.056A.U., p <0.001). IMA levels >0.325A.U. demonstrated a sensitivity of 91.4% and a specificity of 45.7% for the diagnosis of incomplete STR; the area under the receiver operator characteristic curve was 0.849 (95% CI 0.77–0.92, p =0.0001). Moreover, IMA values were an independent predictor of incomplete STR even after adjustment for potential confounders (OR 2.34; 95% CI 1.20–4.64, p = 0.01). Conclusions: IMA may be a useful biomarker for the identification of incomplete STR in STEMI patients presenting to hospital within 6h of the onset of pain. [Copyright &y& Elsevier]

Abstract: Background: Levosimendan is a new calcium sensitizer with positive inotropic properties. In previous studies, it has recently been shown that levosimendan improves the Doppler echocardiographic parameters of the left ventricular (LV) diastolic function in patients with anterior acute myocardial infarction. We sought to evaluate the effects of levosimendan compared to dobutamine on LV diastolic function, using conventional transmitral Doppler, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who subsequently developed cardiogenic shock. Methods: We randomized 22 consecutive STEMI patients with cardiogenic shock after primary PCI to levosimendan or dobutamine infusion and we also analyzed the diastolic function using conventional transmitral Doppler flow. Results: Twenty-four hours after the initiation of the drug infusion, patients treated with levosimendan (n =11) showed a significant reduction of the isovolumetric relaxation time (116±15.2–70.4±10.8 ms; P <.001), and a significant increase of the E/A ratio (0.6±0.3–1.4±0.5; P <.001). In the dobutamine group (n =11), no statistically significant differences were noted in the echocardiographic Doppler indexes. Conclusion: Levosimendan seems to be effective in improving the Doppler echocardiographic parameters of LV diastolic function in patients with STEMI revascularised by primary PCI who developed cardiogenic shock. [Copyright &y& Elsevier]