VALUE OF MATRIX METALLOPROTEINASE AS A PREDICTOR OF OUTCOME OF ACUTE MYOCARDIAL INFARCTION

Abstract

Background: Following acute myocardial infarction (AMI) many cytokines and proteolytic enzymes are released. Among these, matrix metalloproteinases (MMPs) are important proteolytic enzymes that lead to degradation of the extracellular matrix and to change in cardiomyocytes in both infracted and noninfarcted myocardium. This process is known as cardiac remodelling. It has been demonstrated that more than one type of MMP is present in the circulation after cardiomyocye injury. A number of studies have demonstrated the correlation between these MMP levels and the severity of coronary lesion, the prognosis of left ventricular dimension and the survival rate following AMI.
Aim of the work To assess the usefulness of matrix metalloproteinase and other factors as predictors of outcome of patients with acute myocardial infarction.
Patients and methods: This study was done in Cardiology department and biochemistry department, Zagazig University on 92 patients; 75 males (81.5%)) 17 females (18.5%) with acute myocardial infarction. Patients were divided into 4 groups ; group I(Revascularization),group II (Morbidity),group III(Mortality),group IV(Control) All patients were subjected to full laboratory examination and Plasma MMP-3 was measured , wall motion score index(WMSI) ,systolic and diastolic function were assessed by echocardiography pre-discharge and after 6 months .
Results: MMP-3 peaked prior to discharge. MMP-3 was associated with patient cholesterol (p<0.001), triglyceride (p<0.05) ,WMSI (p<0.05) and Gensini score (p<0.001). MMP-3 inversely correlated with fractional shortening at follow-up (p=0.019), Ejection fraction and Isovolumic relaxation time In the 37 patients who had complications or died, MMP-3 was higher (p<0.001). And subjects with levels above optimum cut off identified via ROC curve were more likely to suffer a clinical event (p=0.000).
Conclusion: MMP-3 is associated with left ventricular dysfunction, adverse left ventricular remodelling and prognosis after AMI.
Key words: matrix metalloproteinase ,acute myocardial infarction.