title: Tissue plasminogen activator antigen predicts medium-term left ventricular end-systolic volume after acute myocardial infarction.
abstract: Von Willebrand factor (VWF) and tissue plasminogen activator (t-PA) predict adverse cardiovascular outcome following acute myocardial infarction (AMI) and are weakly associated with pre-discharge left ventricular ejection fraction (LVEF). We examined the relationships between VWF, t-PA antigen, matrix metalloproteinase (MMP)-2,-3, and -9, and B-type natriuretic peptide (BNP), and their predictive effect on serial change in LV volumes in a cohort of patients admitted with AMI. Plasma VWF, t-PA antigen, MMP-2,-3,-9, and BNP were measured at a mean 46 h after AMI in 100 patients (mean age 58.9 +/- 12 years, 77% male) with depressed LVEF. Cardiac magnetic resonance (CMR) imaging was then performed. Biomarker measurement and CMR were repeated at 12 and 24 weeks. Plasma concentrations of VWF, BNP and MMP-9 were elevated while t-PA antigen concentration was at the upper limits of normal; over 24 weeks VWF, t-PA antigen, MMP-9 and BNP decreased significantly. Baseline VWF correlated with BNP (r = 0.35, P < 0.001) and MMP-3 (r = 0.24, P = 0.019) as did t-PA antigen (r = 0.27, P = 0.007 for BNP; r = 0.40, P < 0.001 for MMP-3). t-PA antigen, VWF, MMP-3 and BNP were univariate predictors of LV end-systolic volume at 24 weeks; tPA antigen and BNP remained significant independent predictors on multivariate analysis. t-PA antigen and VWF are related to medium-term LV volumes after AMI, and to MMP-3. This novel link between the coagulation-fibrinolysis system and matrix turnover merits further study in understanding the pathophysiology of adverse ventricular remodeling after AMI.
authors: Cardiology Department, Western Infirmary, Glasgow, Scotland, UK. robinweir75@hotmail.com
authors: Robin A P
authors: RA
authors: Weir
authors: Sean
authors: S
authors: Balmain
authors: Tracey
authors: T
authors: Steedman
authors: Leong L
authors: LL
authors: Ng
authors: Iain B
authors: IB
authors: Squire
authors: Anne
authors: A
authors: Rumley
authors: Henry J
authors: HJ
authors: Dargie
authors: Gordon D O
authors: GD
authors: Lowe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D000077545:Eplerenone; D005260:Female; D006801:Humans; D008297:Male; D020782:Matrix Metalloproteinases / Q000097:blood; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D013148:Spironolactone / Q000008:administration & dosage / Q000031:analogs & derivatives; D013318:Stroke Volume; D010959:Tissue Plasminogen Activator / Q000097:blood*; D020257:Ventricular Remodeling; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D000451:Mineralocorticoid Receptor Antagonists; D014841:von Willebrand Factor; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D000077545:Eplerenone; D010959:Tissue Plasminogen Activator; D020782:Matrix Metalloproteinases