Impact of concentration of apelin-13 and chosen proangiogenic factors on the left ventricle function in echocardiographic assessment after myocardial infarction
Authors: Sawicka M , Sawicka M , Janowska J , Streb W , Mitrega K , Kalarus Z 
Published: November 2020

Abstract

Introduction
Myocardial infarction (MI) is one of the main factors of heart failure (HF) development, therefore it is essential to search possibilities of prevention of its occurance in that condition.

Purpose
The study aimed to determine the association between serum concentrations of apelin-13, vascular endothelial growth factor-A (VEGF-A), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and systolic function of the left ventricle after MI.

Methods
Study group included 67 consecutive patients with acute MI (STEMI and NSTEMI) and lack of previous diagnosis of systolic HF. Venous blood samples were drawn prior to coronary intervention, on the third and fifth day of MI. The blood samples were centrifuged (3000g /15 minutes), serum was frozen and stored at −80°C before further analysis. Concentrations of the studied substances were determined by ELISA tests. Ejection fraction (Simpson's method) and mass (linear method) of the left ventricle were calculated in echocardiographic examination on the fifth day of MI. Cut off values for impaired left ventricular ejection fraction (LVEF) were 54% (women) and 52% (men). The concentrations of the studied factors were indexed to the left ventricle mass. In statistical analysis Mann-Whitney test and the logistic regression were used. Two models for proper LVEF occurance were tested. 1st model included time from pain onset to coronary intervention, type of MI, sex, eptifbatide use and heparin total dose; 2nd model included hypertension, diabetes mellitus, BMI, LDL concentration, smoking and age; each model included indexed concentration of one of the studied factors.

Results
STEMI was diagnosed in 45 (67%) patients. 53 patients (79%) did not achieve normal LVEF. Persons with normal LVEF exhibited statistically significant higher value of indexed concentrations of apelin-13 and VEGF-A on the first (respectively p=0.02 and p=0.03) and fifth (respectively p=0.004 and p=0.03) day of MI. In the logistic regression, odds ratio (OR) of indexed apelin-13 from the fifth day of MI, in the 1st model was 1.36 (95% CI: 1.04–1.78, p=0.02) and in the 2nd model was 1.43 (95% CI: 1.11–1.84, p=0.01); OR of indexed VEGF-A from the fifth day, in the 2nd model, was 13.65 (95% CI: 1.18–158.11, p=0.03). Indexed VEGF-A from the fifth day in the 1st model and indexed concentrations of both factors from the first day, notwithstanding type of model, did not obtain statistically significant OR. In the logistic regression inluded only indexed apelin-13 and VEGF-A from the fifth day of MI, OR was respctively 1.54 (95% CI: 1.15–2.06, p=0.003) and 22.39 (95% CI: 1.68–298.59, p=0.02). Ang-1 and Ang-2 did not exhibit statistically significant impact on LVEF.

Conclusions
Apelin-13 and VEGF-A exhibit properties, which may prevent deterioration of LVEF and thus avoid HF in patients with MI. Dose adjustment should be based on the left ventricle mass. Optimal time of administration of both substances is an issue of further studies.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia