Myeloperoxidase and global longitudinal strain as markers of major adverse cardiac events in patients after ST-segment elevation myocardial infarction after 12 months

Abstract

Acute ST-segment elevation myocardial infarction (STEMI) remains a challenging clinical condition and a major contributor to morbidity and mortality worldwide. Elevated levels of the inflammatory biomarker myeloperoxidase (MPO) and left ventricular global longitudinal strain (GLS) appear to be a promising predictors in STEMI patients.

Aim

To evaluate the impact of body fat accumulation (BFA), MPO and GLS on the prediction of 1-year major adverse cardiac events (MACE) in STEMI patients successfully treated with primary percutaneous coronary intervention (PCI) with respect to abdominal obesity.

Methods

We prospectively enrolled 102 patients with STEMI who underwent successful primary PCI with post-procedural TIMI flow >2. Patients were followed up through visits or telephone interviews at 6, 24, 52 weeks after STEMI to assess clinical outcomes that were analysed as a 1-year combined endpoint. Biomarkers (MPO, cardiac troponins) and echocardiographic parameters with speckle-tracking and Doppler were assessed at baseline and after 12 months of the follow-up period.

Results

A total of 102 patients were included in the study. Patients were divided into two groups according to the median MPO level (≥98.34 ng/mL and <98.34 ng/mL). Positive correlations were observed between serum MPO levels and BFA (τ=0.28; P=0.036), NT-proBNP (τ=0.31; P=0.046), as well as an inverse correlation with diastolic blood pressure (τ=−0.14; P=0.038). No significant associations were found between MPO and other cardiac parameters, including heart rate, left ventricular ejection fraction, left atrial volume index, LV end-diastolic volume or LV end-systolic volume (LVESV).

During the follow-up period, 26 combined endpoints were recorded (10 in patients with MPO≥98.34 ng/mL and 16 with MPO<98.34 ng/mL; F-test=0.064; χ²=4.29; P=0.046).

Univariate linear regression analysis showed that BFA had a borderline impact on the dependent variable, whereas GLS and MPO demonstrated a significant association with the combined endpoint. In multivariate linear regression analysis, only GLS and MPO remained independent predictors of MACE.

Receiver operating characteristic (ROC) curve analysis demonstrated that predictive models based on BFA (AUC=0.908; P<0.0001), MPO (AUC=0.721; P<0.005), and GLS (AUC=0.925; P<0.0001) significantly outperformed the baseline model and effectively identified patients at increased risk of adverse outcomes.

Comparison of predictive models using the maximum likelihood ratio test showed that GLS was the strongest predictor of poor clinical outcomes in STEMI patients, whereas MPO demonstrated the highest negative likelihood ratio. BFA showed borderline significance compared with GLS but had superior predictive value compared with MPO.

Conclusion

Our study demonstrated that GLS was the most powerful predictor of 1-year clinical outcomes in STEMI patients with successful PCI. BFA and MPO were also independent markers in MACE prediction.Study designFor image description, please refer to the figure legend and surrounding text.ROC curve predictive modelsFor image description, please refer to the figure legend and surrounding text.