The Corelation Between Plasminogen Activator Inhibitor-1 And Recent Left Ventricular Remodeling And Prognosis After Acute Myocardial Infarction

Objective:To evaluate the corelation between plasminogen activator inhibitor-1 (PAI-1) and recent left ventricular remodeling and prognosis after acute myocardial infarction(AMI) and analyze the estimated value of PAI-1 in patients with recent left ventricular remodeling after AMI.Method:In 67 patients(age,68.9±11.35years) with initial AMI, plasma PAI-1,B-type natriuretic peptide(BNP),fibrinogen(FIB) and related biochemic index were determined. The data of medical history,physical examination and treatment was recorded in detail. Within the 72 hours after AMI, left ventricular end diastolic volume index(LVEDVI),left ventricular ejection fraction(LVEF) and left ventricular mass index(LVMI) were measured and calculated by echocardiography. The 60 survival patients were received echocardiography to measure and calculate LVEDVI,LVEF,LVMI after 6 weeks. The left ventricular remodeling was defined by△LVEDVI≥20% and the patients were divided into left ventricular remodeling group and non left ventricular remodeling group. T test and Wilcoxon Mann-Whitney test was used to analyze the differences of plasma PAI-1,BNP and clinical data between survival group and death group, as well between left ventricular remodeling group and non left ventricular remodeling group. Spearman rank correlation was used to evaluate the relation between PAI-1 and the echocardiographic index, then logistic analytical method was used to quantitatively analyze the relevance between PAI-1 and left ventricular remodeling. The reciever operator characteristic curve(ROC) was used to discuss the diagnostic value of PAI-1 in the patients with left ventricular remodeling after AMI and find the best diagnostic cut-off point.Results:(1) In 67 patients(average age 68.9±11.35years) of AMI,7 of them occur cardiac death in the hospital. The plasma PAI-1 concentration in the death group were significantly higher than in the survival group(57.01±8.72ng/ml vs 45.80±13.88 ng/ml, P=0.014). (2) Using△LVEDVI to divide the 60 survival patients(average age 68.17±11.40years) into left ventricular remodeling group(n=19) and non left ventricular remodeling group(n=41). The plasma PAI-1 concentration in the left ventricular remodeling group were significantly higher than in the non left ventricular remodeling group (60.27±11.64 ng/ml vs 47.85±14.91 ng/ml, P< 0.001). Correlation analysis showed that the plasma PAI-1 concentration was positively related to LVEDVI during 72 hours after AMI,LVEDVI and LVMI after 6 weeks and△LVEDVI(rs=0.387,0.269,0.253,0.562; P=0.002,0.038,0.001, <0.001), but negatively related to LVEF after 6 weeks(rs=-0.206, P< 0.001). Logistic regression analysis showed that according to the dependent variable left ventricular remodeling, high BNP and high PAI-1 were related to left ventricular remodeling(B=0.325,0.020; P=0.049,0.012). The ROC curve showed that area under the curve of PAI-1 was 0.915 and the result was significant. On the basis of ROC curve, the best diagnostic cut-off point was defined to 51.60ng/ml. (3) The patients(n=33) with coronary artery recanalization were divided into left ventricular remodeling group(n=8) and non left ventricular remodeling group(n=25) according to△LVEDVI. The plasma PAI-1 concentration in the left ventricular remodeling group were significantly higher than in the non left ventricular remodeling group (63.37±7.15ng/ml vs 41.67±8.79 ng/ml, P=0.002). Correlation analysis showed that the plasma PAI-1 concentration was positively related to△LVEDVI (rs=0.576, P=0.002)Conclusion:(1)In the patients after AMI, The plasma PAI-1 concentration in the left ventricular remodeling group were significantly higher than that in the non left ventricular remodeling group. The plasma PAI-1 concentration was positively related to the index of left ventricular remodeling△LVEDVI. Logistic regression analysis and ROC curve comfirmed that plasma PAI-1 is the effectively predicted index about recent left ventricular remodeling after AMI independent of BNP, coronary artery recanalization, infarction position, et al. (2) The plasma PAI-1 concentration was significantly increased in the AMI patients that occurred cardiac death in the hospital. The increasing plasma PAI-1 concentration might be considered to be the predicted index to the recently cardiac death after AMI.