Blood PGC-1a Concentration Predicts Myocardial Salvage and Ventricular Remodeling After ST-segment Elevation Acute Myocardial Infarction

Introduction and objectives: Peroxisome proliferator-activated receptor gamma coactivator 1a (PGC-1a) is a metabolic regulator induced during ischemia that prevents cardiac remodeling in animal models. The activity of PGC-1a can be estimated in patients with ST-segment elevation acute myocardial infarction. The aim of the present study was to evaluate the value of blood PGC-1a levels in predicting the extent of necrosis and ventricular remodeling after infarction. Methods: In this prospective study of 31 patients with a first myocardial infarction in an anterior location and successful reperfusion, PGC-1a expression in peripheral blood on admission and at 72 hours was correlated with myocardial injury, ventricular volume, and systolic function at 6 months. Edema and myocardial necrosis were estimated using cardiac magnetic resonance imaging during the first week. At 6 months, infarct size and ventricular remodeling, defined as an increase > 10% of the left ventricular end-diastolic volume, was evaluated by follow-up magnetic resonance imaging. Myocardial salvage was defined as the difference between the edema and necrosis areas. Results: Greater myocardial salvage was seen in patients with detectable PGC-1a levels at admission (mean [standard deviation (SD)], 18.3% [5.3%] vs 4.5% [3.9%]; P = . 04). Induction of PGC–1a at 72 hours correlated with greater ventricular remodeling (change in left ventricular end-diastolic volume at 6 months, 29.7% [11.2%] vs 1.2% [5.8%]; P = .04). Conclusions: Baseline PGC–1a expression and an attenuated systemic response after acute myocardial infarction are associated with greater myocardial salvage and predict less ventricular remodeling. 2014 Sociedad Española de Cardiologı́a. Published by Elsevier España, S.L. U. All rights reserved. Los niveles en sangre de PGC-1a predice miocardio salvado y remodelado ventricular tras infarto agudo de miocardio con elevación del segmento ST Palabras clave: PGC-1a Infarto agudo de miocardio con elevación del segmento ST Remodelado ventricular Metabolismo oxidativo Estrés oxidativo R E S U M E N Introducción y objetivos: El coactivador 1a del receptor activado gamma del proliferador de peroxisoma (PGC-1a) es un regulador metabólico que se induce durante la isquemia y previene el remodelado cardiaco en modelos animales. Su actividad puede estimarse en pacientes con infarto agudo de miocardio con elevación del segmento ST. Nuestro objetivo es evaluar el valor predictivo de los niveles en sangre de PGC–1a en la extensión del área necrótica y el remodelado ventricular tras infarto. Métodos: Estudio prospectivo de 31 pacientes con primer infarto de miocardio de localización anterior y reperfusión exitosa. Se determinó la expresión de PGC–1a en sangre periférica al ingreso y a las 72 h, evaluando su correlación con el daño miocárdico y el volumen ventricular y la función sistólica a los 6 meses. El edema y la necrosis miocárdica se estimaron mediante resonancia magnética cardiaca * Corresponding author: Servicio de Cardiologı́a, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces 2, 46014 Valencia, Spain. E-mail address: osfabregat@gmail.com (Ó. Fabregat-Andrés). http://dx.doi. org/10.1016/j.rec. 2014.05. 02