| Objective: Acute myocardial infarction(AMI) is a serious clinical emergency, and it is a serious threat to people’s life. Therefore, in recent years, we are focusing on early reperfusion therapy. Although timely reperfusion can improve the early survival, the left ventricular remodeling after acute myocardial infarction still notably affects heart function, resulting in heart failure, malignant arrhythmia, and end stage death. Thus, we need to actively prevent and treat left ventricular remodeling, aiming to stop, maybe even reverse left ventricular remodeling, in addition to restore perfusion in time.The Wnt signaling pathway is a complex network of proteins, which shows high evolutionary conservation. The Wnt is involved in atherosclerosis, wound healing after myocardial infarction(MI), adverse remodeling, and heart failure. Secreted frizzled-related proteins(SFRPs) are a family of inhibitors, and can block Wnt signaling. Extensive researches revealed that SFRPs can reduce infarct size, improve heart function, and reduce cardiac rupture incidence. Secreted frizzled-related protein 5(SFRP5) is a member of SFRPs. It’s confirmed that SFRP5 is closely associated with inflammation, apoptosis, hypertrophy, and fibrosis. This study aims to observe the serum SFRP5 expression levels in patients with AMI, and determine the relationship between serum SFRP5 level and the risk factors of cardiovascular disease, as well as left ventricular remodeling.Methods: From December, 2013 to July, 2014, a total of 83 patients with ST-segment elevation acute myocardial infarction that were treated in the No.2 Affiliated Hospital of Hebei Medical University were enrolled in the study. The diagnosis of AMI was made according to the WHO Acute Myocardial Infarction criteria. Patients with non-ST-segment elevation acute myocardial infarction, remote MI, rheumatic heart disease, cardiomyopathy, myocarditis, heart failure, infectious diseases such as hepatitis, inflammatory disease, and malignant tumor were excluded. All of the patients with AMI were admitted within 48 hours after symptoms onset and the fasting peripheral venous blood samples were drawn on the third day after onset to measure the level of serum SFRP5 by an enzyme-linked immunosorbent assay(ELISA). Echocardiogram was performed at one week and at 6 months follow-up after the AMI onset. We measured left ventricular end-diastolic diameter(LVEDD), interventricular septal thickness in diastole(IVSD), and left ventricular posterior wall thickness in diastole(LVPWD). The data of left ventricular end-diastolic volumes(LVEDV), left ventricular end-systolic volumes(LVESV), and left ventricular ejection fraction(LVEF) were measured by the Simpson method. All the AMI patients were divided into two groups: left ventricular remodeling group and no left ventricular remodeling group. Remodeling was defined as an at least 10% increase from baseline in the left ventricular end-diastolic volume. 33 healthy persons were selected as the control group. Serum SFRP5 levels of the participants were measured by ELISA. Record the clinical parameters of all subjects in detail, including name, gender, age, height, weight, history of smoking, cardiovascular disease risk factors such as hypertension, diabetes, and dyslipidemia, and family history. All participants underwent blood test, electrocardiography(ECG), chest X-ray, and echocardiogram. The patients with AMI were given routine medical treatment, and some received thrombolytic therapy or percutaneous coronary intervention(PCI). Statistical analysis was performed using SPSS 19.0 for Windows. Continuous variables are presented as the mean ± standard deviation. The differences between the two groups were evaluated with an independent-samples t-test and Chi-square test. Correlations between 2 variables were assessed by using a pearson correlation analysis. Associations between the presence of left ventricular remodeling and clinical/biochemical parameters(including age, gender, smoking, body mass index(BMI), blood lipid, blood glucose, the presence of hypertension, and serum SFRP5) were analyzed by Logistic regression analysis. All p-values were two-tailed and a level of p < 0.05 was considered statistically significant.Results:1 Compared to the control group(55.7±12.11ng/ml), the levels of serum SFRP5, in both left ventricular remodeling group(36.26±10.73ng/ml) and no left ventricular remodeling group(43.01±10.38ng/ml) were both decreased significantly(P<0.01). There was significant difference in the levels of serum SFRP5 between the left ventricular remodeling group and the no left ventricular remodeling group(P<0.01).2 No differences were found in the left ventricular remodeling group and the no left ventricular remodeling group in the comparison of age, gender, BMI, history of smoking, the prevalence of dyslipidemia, diabetes or hypertension, total cholesterol(TC), triglycerides(TG), high-density lipoprotein(HDL), fasting blood glucose, and medication(P>0.05). There were differences in infarction location(P<0.01) and low density lipoprotein(LDL)(P<0.05).3 For all AMI patients, the levels of serum SFRP5 were not correlated with TC, TG, HDL, LDL, and fasting blood glucose(P>0.05). BMI showed a negative correlation(r=-0.436, P<0.01).4 There were no significant differences between the left ventricular remodeling group and the no left ventricular remodeling group in LVEDV(110.5±22.99 ml vs. 108.81±23.54 ml, P>0.05) and LVEF[(54.31±10.23)% vs.(55.77±8.95)%, P>0.05] at 7 days post-MI. At 6 months after AMI, the LVEDV of the remodeling group was 110.5±22.99 ml, and the LVEF was(48.72±8.91)%, while the LVEDV of the non-remodeling group was 114.46±24.27 ml, and the LVEF was(53.38±7.06)%. From 7 days to 6 months after MI, the change of LVEDV and LVEF in the remodeling group were 16.5±3.67 ml and(-5.59±5.34)% respectively, while the change of LVEDV and LVEF in the non-remodeling group was 5.87±2.41 ml and(-2.52±3.04)% respectively.5 The levels of serum SFRP5 in ventricular remodeling group were negatively correlated with ΔLVEDV(r=-0.408, P<0.05), and significantly and positively correlated with ΔLVEF(r=0.428, P<0.05).6 For the Logistic regression analysis of the AMI patients, the level of serum SFRP5 was significantly associated with left ventricular remodeling.Conclusion:(1) The levels of serum SFRP5 in AMI patients decrease remarkably compared with the control group.While the levels of serum SFRP5 in the left ventricular remodeling group is significantly lower than the no left ventricular remodeling group. SFRP5 may be a protective factor in ventricular remodeling after AMI.(2) Serum SFRP5 is an independent predictor of post-MI left ventricular remodeling. |
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