Method for prediction of left ventricular postinfarction dilatation

FIELD: medicine.

SUBSTANCE: patient's blood serum taken on the first three days following the myocardial infraction is examined for the level of a tissue inhibitor of type 1 metalloproteinase (TIMP-1) and the concentration of vascular cell adhesion molecules (sVCAM-1) to calculate a repair coefficient (RC) by formula: RC=TIMP 1 /sVCAM1, and if the CR values exceeds 0.94, the developing left ventricular postinfarction dilatation is predicted.

EFFECT: early prediction of the developing left ventricular postinfarction dilatation, including of the symptom-free forms.

3 ex, 1 tbl

 

The invention relates to medicine, namely cardiology, and can be used for assessment in the acute stage of myocardial infarction the risk of dilatation of the left ventricle during the first year after myocardial infarction.

In modern literature there is information about the use of natriuretic peptides (tap) atrial (PT) and brain-type (MT), and aminoanisole brain natriuretic propecia type (NT-proBNP) to confirm or refute the diagnosis of heart failure (Wu A.N., Apple F.S., Gibler W.., Jesse R.L., Warshaw M.M., Valdes R.Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases // Clin Chem. - 1999. - Vol.45. - P.1104-1121). However, it is shown that the concentration of natriuretic peptides in the blood is influenced by many factors, including age, sex, condition of the thyroid gland, anemia, and obesity. This leads to the complexity of the interpretation of the results should be interpreted only in the clinical context of related conditions. There is no reliable guidance on the use of natriuretic peptides to identify groups of individuals at high risk for development of post-infarction asymptomatic dilatation of the left ventricle, and, given the variety of pathogenetic factors leading to the expansion of the left heart chambers, N. triturations peptide does not reflect the specificity of postinfarction remodeling of the left ventricle. In the available literature we did not find ways to predict post-infarction left ventricle dilatation.

Technical result: early prediction of the development of post-infarction left ventricle dilatation, including asymptomatic forms.

The essence of the method consists in determining the serum of venous blood collected in the acute phase of myocardial infarction (within the first three days after a heart attack), the level of serum marker of metabolism of collagen, tissue inhibitor of matrix metalloproteinase-1 type (TIMP-1) and concentration of molecules intercellular adhesion to the vascular endothelium (sVCAM-1), followed by calculation of the coefficient repair (CR) by the formula CR=TIMP1/sVCAM1. The coefficient of reparation characterizes the balance between system collagenopathy and repair system. When the magnitude of the coefficient repair more than 0,94 predict the development of post-infarction left ventricle dilatation in the coming year developed after myocardial infarction.

The method is as follows.

In subjects with a diagnosis of acute myocardial infarction during the first three days after myocardial infarction take blood from the cubital vein in a volume of 10 ml without anticoagulant, defend for one hour, then centrifuged for 20 min with a speed of 2000 rpm and get savoro the ku blood. Then spend a solid phase enzyme-linked immunosorbent assay (ELISA) using a diagnostic kit company BenderMedSystem (Vienna, Austria) for the quantitative determination of tissue inhibitor of matrix metalloproteinases type 1 (TIMP-1) and molecules intercellular adhesion to the vascular endothelium (sVCAM-1). Calculate the coefficient of reparation (KR) according to the formula CR=TIMP1/sVCAM1. When the magnitude of the coefficient repair more than 0,94 predict the development of post-infarction left ventricle dilatation in the coming year installed after myocardial infarction.

The survey was attended by 39 people admitted to the intensive care unit with a diagnosis of acute myocardial infarction. All patients with acute myocardial infarction was diagnosed according to the criteria established by the recommendations of GFCF. Within three days after myocardial infarction all patients was determined by the concentration of TIMP-1 and sVCAM-1 in the serum of venous blood. The sizes of the chambers of the heart (end-diastolic volume of the left ventricle) investigated simultaneously with blood sampling and one year after discharge, respectively, LV EDV1and LV EDV2. 26 people through the observation year end-diastolic volume increased in 25 of them - the value of the coefficient of reparation exceeded 0,94.

Examples of specific performance:

Example 1. Female P., 73. He enrolled in the intensive care unit with the automotive technician is zoom acute myocardial infarction of posterior-lateral localization. On ultrasound of the heart during the acute stage of myocardial infarction end-diastolic volume of the left ventricle (LV EDV1) was 85 ml, in the serum level of TIMP-1 - 1335 ng/ml, the level of sVCAM-1 - 2040 ng/ml Coefficient of reparation was 0.65. One year after myocardial infarction by echocardiography revealed a decrease in LV EDV2to 55 ml, i.e. post dilatation has not developed.

Example 2. Man, 55 years. He enrolled in the intensive care unit with a diagnosis of acute anterior septal involving the tops of myocardial infarction. On ultrasound of the heart during the acute stage of myocardial infarction, LV EDV1- 63 ml, in the serum level of TIMP-1 - 1390 ng/ml, the level of sVCAM-1 - 585 ng/ml Coefficient of reparation was 2,38. One year after myocardial infarction by echocardiography revealed an increase in LV EDV2up to 105 ml, i.e. the development of post-infarction left ventricle dilatation.

Example 3: a Man F., 70 years. He enrolled in the intensive care unit with a diagnosis of acute myocardial infarction of posterior-lateral localization. On ultrasound of the heart during the acute stage of myocardial infarction, LV EDV1158 ml, in the serum level of TIMP-1 - 1870 ng/ml, the level of sVCAM-1 - 1770 ng/ml Coefficient of reparation was 1.06. One year after myocardial infarction by echocardiography revealed an increase in LV EDV2to 165 ml, i.e. the development of post-infarction left ventricle dilatation.

The sequence number of the patientBWW LV2 (a year)- LV EDV1 (AMI)(ml)The coefficient of reparation (TIMP-1/sVCAM-1)1-21,032-300,653151,794-240,91571,066-440,557161,038-150,739-270,4910-30,0411351,2612-11 13121,71461,0115191,041660,96172of 1.341891,3019-60,622081,1821191,7522-130,7123221,592481,9125-230,782651,82 27230,9028422,3829141,4330-60,3931-90,9432101,9333451,3934551,183515of 1.5736240,8137630,983825239750,94

Pros: the simplicity of the method, the possibility of detection with a sensitivity of 92% and the specificity 92%, among persons with acute myocardial infarction, high risk asymptomatic post-infarction left ventricle dilatation in the course of the next year to develop therapeutic approaches and strategies to reduce the risk.

A method for predicting post-infarction left ventricle dilatation, which consists in the fact that the patient's serum taken in the first three days after myocardial infarction, determine the level of tissue inhibitor of matrix metalloproteinase-1 type (TIMP-1) and the concentration of molecules intercellular adhesion to the vascular endothelium (sVCAM-1), calculate the coefficient of reparation (KR) according to the formula KP=TIMP-1/sVCAM-1 and when the value of CR more than 0,94 predict the development of post-infarction left ventricle dilatation.



 

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