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Low circulating melatonin levels predict poor outcome in patients with ST-segment elevation myocardial infarction (STEMI). In the present study, we investigated whether a relationship between myocardial deformation in parameters measured by echocardiography and circulating melatonin level exists. We prospectively included 112 patients with STEMI who performed echocardiography and simultaneous measurement of serum melatonin, during the light period within 72 h of admission. We found a negative correlation between circulating melatonin levels and global longitudinal strain ( p = 0.006, r = −0.33). In conclusion, melatonin levels have a correlation with two-dimensional speckle tracking in patients with STEMI. [ABSTRACT FROM AUTHOR]

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: Introduction: We sought to investigate whether day-night variations occur in the concentration of circulating soluble CD40 ligand in patients with acute coronary syndrome, as this may have practical implications. Materials and Methods: We assessed 70 consecutive ST-segment elevation myocardial infarction patients admitted into the Coronary Care Unit and 50 control subjects. Each subject was studied under strictly controlled light/dark conditions. Blood samples were drawn at 09:00 h (light phase) and 02:00 h (dark phase). Nocturnal blood samples were drawn by a trained nurse, with the help of a minute torch with a dim red light in order to avoid any direct lighting on the patient during sleep. The soluble CD40 ligand was measured using a commercially available ELISA. Results: Soluble CD40 ligand levels showed no diurnal variations in control subjects. In the ST-segment elevation myocardial infarction group, however, soluble CD40 ligand concentration (pg/mL) in the light phase was significantly higher than that in the dark phase (167.3±63.2 vs 118.9±48.3 pg/mL, p<0.001). Conclusions: The study shows for the first time the existence of diurnal variations in soluble CD40 ligand levels in ST-segment elevation myocardial infarction patients, which indicates the need for standardizing the time of blood sampling for the assessment of this molecule, at least in studies involving ST-segment elevation myocardial infarction patients. [Copyright &y& Elsevier]

Background: The aim of the present study was to evaluate whether or not an elevated ischaemia-modified albumin (IMA) level provides any additional prognostic information to the validated Thrombolysis In Myocardial Infarction (TIMI) risk score in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: One hundred seven consecutive STEMI patients treated with primary PCI were included. The incidence of 30-day death was the prespecified primary end point. Serum IMA was measured immediately at hospital arrival. Results: The incidence of the primary end point was 6.5%. A significant predictive value of IMA in relation to the primary end point was indicated by an area under the ROC curve of 0.71 (p = 0.01). In the multivariate analysis, increased IMA remained a significant predictor of the primary end point after adjustment for TIMI risk predictors (p = 0.019). The area under the ROC curve for the TIMI risk score was 0.68 (p = 0.03). The addition of IMA to the TIMI risk score did not improve its prognostic value (area under the ROC curve 0.60, p = 0.25). Conclusion: IMA levels obtained at admission are a powerful indicator of short-term mortality in STEMI patients treated with primary PCI, but do not seem to be a marker that adds prognostic information to the validated STEMI TIMI risk score. [ABSTRACT FROM AUTHOR]

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]

Abstract: Background: Ischemia-modified albumin (IMA) has been shown to be elevated in patients after percutaneous coronary intervention (PCI). Our goal was to investigate the association between IMA levels and left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction (STEMI) treated with PCI and who developed heart failure during their Coronary Care Unit (CCU) stay. Methods: We assessed 75 patients with a first STEMI. Presence of heart failure was assessed during CCU admission, and patients were subdivided into 2 groups: group A (n =45) comprised patients in Killip class I, and group B (n =30) Killip classes>I. Serum IMA concentration was measured within the first 15 min post-PCI. The IMA measured was performed using an indirect method based in the Albumin Cobalt Binding (ACB) colorimetric assay. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis. Results: Serum IMA concentrations were significantly higher in group B than in group A (0.37±0.09 vs 0.30±0.06 (A.U.); p <0.0001). The sensitivity and specificity of IMA for heart failure were 93.3% and 37.7%, respectively, at 0.31 A.U. Multivariable adjustment IMA showed a significant inverse correlation with left ventricular ejection function (r =−0.32; p =0.004). On multivariable analysis both IMA (OR=2.1, 95%CI: 1.2 to 3.9, p <0.001) and left ventricular ejection function (OR=1.7, 95%CI: 1.1 to 2.1, p <0.01) correlated with the occurrence of heart failure. Conclusion: In patients with STEMI undergoing PCI, serum IMA concentrations are significantly related to LVEF and represent an early marker of left ventricular dysfunction. [Copyright &y& Elsevier]

Elevated levels of soluble cellular adhesion molecules have been reported in patients with acute coronary syndromes. Likewise, a relation between decreased nocturnal melatonin levels and coronary artery disease has been suggested. The aim of the present study was to investigate the day–night variations in the concentration of soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with ST-segment elevation myocardial infarction (STEMI) in relation to the light/dark melatonin pattern. Ninety consecutive patients with STEMI who were admitted to the Coronary Care Unit of our institution were studied. We also recruited 70 age- and gender-matched healthy normal subjects. Blood samples were drawn at 09:00 and 02:00 hr, while patients were at rest, for the assessment of sVCAM-1 and melatonin, which were measured using commercially available ELISA. In STEMI patients, melatonin concentrations maintained a diurnal variation, but the difference between nocturnal and diurnal levels was less than that in healthy subjects ( P < 0.0001). In contrast to findings with melatonin, sVCAM-1 levels showed no diurnal variations in control subjects. In the STEMI group, however, sVCAM-1 concentration at 02:00 hr was significantly higher than that during the light phase (09:00 hr; 1391 ± 38 versus 1200 ± 43 ng/mL, P < 0.05). The results suggest that diurnal variations in endogenous sVCAM-1 production in STEMI patients might be related to an attenuated circadian secretion of melatonin. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The purpose of this study was to compare serum matrix metalloproteinase (MMP)-9 levels in a population of type 2 diabetic versus non-diabetic patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and to examine the relationship between serum MMP-9 levels and the incidence of in-hospital cardiac events, including death and cardiogenic shock. Methods: We recruited 120 patients with STEMI, of whom 48 were type 2 diabetic and 72 non-diabetic. Serum MMP-9 levels were measured on admission, using a commercially available ELISA. The primary study endpoint was cardiac death in-hospital and cardiogenic shock. Results: Mean serum MMP-9 levels were significantly higher in type 2 diabetic patients compared to non-diabetic patients (240±52ng/mL versus 185±47ng/mL; P <0.0001). In multivariable analysis, type 2 diabetes was an independent factor for mortality [OR: 1.75 (1.40–2.30); P =0.005] and cardiogenic shock [OR: 1.55 (1.20–1.70); P =0.03] when the variable MMP-9 level was not introduced into the model, but it was less significantly associated with mortality [OR: 1.60 (1.40–2.10); P =0.01] and no longer associated with cardiogenic shock when MMP-9 was in the model. Conclusion: After STEMI, type 2 diabetes is independently associated with high serum MMP-9 levels. This elevated MMP-9 is strongly associated with the increased incidence of in-hospital mortality and cardiogenic shock observed in type 2 diabetes. Our findings clearly indicate that serum MMP-9 provides a highly valuable prognostic information on in-hospital outcome after STEMI, in particular in type 2 diabetic patients. [Copyright &y& Elsevier]

Abstract: Introduction: The balance between pro-inflammatory and anti-inflammatory molecules is likely to modulate the processes that lead to atherogenesis and rapid coronary artery disease progression. We sought to compare the positive predictive values of serum soluble CD40 ligand (sCD40L)/interleukin-10 (IL-10) ratio, versus individual sCD40L, and IL-10 measurements regarding in-hospital events in patients admitted into the hospital with ST-segment elevation myocardial infarction (STEMI). Methods: We recruited 96 patients with STEMI. sCD40L and IL-10 were measured at hospital admission in every patient. The composite of in-hospital death and heart failure represented the study end-point. Heart failure was defined as Killip class>1. Multivariable logistic regression analysis was performed to identify independent variables related to in-hospital events. Results: Thirty two patients (33%) achieved the study end-point and 64 (67%) had no adverse events during hospital admission. IL-10 levels (pg/ml) were lower (28.2±9.8 versus 33.24±11.3, p =0.03) and sCD40L levels (pg/ml) higher (156.8±54.2 versus 135.4±38.70, p =0.02) in patients with events compared to those without events. Significantly higher odd ratios were found for sCD40L/IL-10 ratio (OR=2.10, 95% CI: 1.90 to 2.80, p =0.01) compared to individual sCD40L (OR=1.40, 95% CI: 0.90 to 2.20, p =0.08) and IL-10 (OR=0.70, 95% CI: 0.50 to 0.93, p =0.02) measurements. Conclusion: Our study showed that serum ratio of sCD40L/IL-10 is a better independent predictor of in-hospital adverse events than individual sCD40L and IL-10 measurements in patients with STEMI. [Copyright &y& Elsevier]

Abstract: Myeloperoxidase (MPO) is a marker of inflammation that has been suggested to have prognostic role in patients with acute coronary syndrome. We sought to investigate whether day–night variations occur in the concentration of circulating MPO in patients with ST-segment elevation myocardial infarction (STEMI), as this may have practical implications. We assessed 70 consecutive STEMI patients admitted to the Coronary Care Unit and 50 age- and gender-matched apparently healthy control subjects. Blood samples were drawn at 09:00 a.m. (light phase) and 02:00 a.m. (dark phase). MPO was measured using a commercially available ELISA. MPO levels showed no diurnal variations in control subjects. In STEMI group, however, MPO concentration (ng/mL) in the dark phase was significantly higher than that in the light phase (83.30±33.08 vs. 64.10±31.30, p <0.001). The study shows for the first time the existence of diurnal variations in MPO levels in STEMI patients, which indicates the need for standardizing the time of blood sampling for the assessment of this molecule. [ABSTRACT FROM AUTHOR]

Abstract: Background: Patients with baseline renal dysfunction (BRD) have an increased cardiovascular risk and a worse prognosis after an acute myocardial infarction (AMI). Besides, the appearance of worsening renal failure (WRF) after an AMI is an independent predictor of worse prognosis too. The aim of the present study was to determine the in-hospital prognostic significance of BRD and WRF in patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful primary angioplasty (PA). Methods: Seventy-six consecutive patients with STEMI diagnosis were admitted to our department and treated with PA successfully. Two groups were established in relation to the presence of BRD on admission (defined by a ClCr<60 ml/min/1.73 m2, estimated by the modification of diet in renal disease equation). We compared their baseline characteristics and their in-hospital mortality and developing of WRF. Results: BRD was associated to a greater in-hospital mortality (11.5% vs. 2.7%, p =0.009) and a higher incidence of WRF (12.2% vs. 2.5%, p <0.001). After adjusting by confounding factors, the multiple logistic regression analysis demonstrated that BRD was an independent predictor of in-hospital mortality (OR 2.5, CI 95% 1.5–3.8, p <0.001). Besides, WRF was associated to a greater in-hospital mortality too, independent of the presence of BRD (OR 1.9, CI 95% 1.3–2.4, p <0.001). Conclusions: BRD was an independent predictor of in-hospital mortality in patients with STEMI who underwent successful PA. Likewise, WRF occurring in these patients was an independent predictor of in-hospital mortality too. [Copyright &y& Elsevier]