Genetic characteristics of patients with left ventricular remodeling after ST-segment elevation myocardial infarction

Aim. To identify genetic characteristics of patients with left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI) with reliable reperfusion.

Material and methods. This single-center observational study included 40 patients with STEMI who successfully underwent PCI. Single nucleotide polymorphisms (SNPs) in genes involved in the renin-angiotensin-aldosterone system, coagulation cascade, platelet function, endothelial function, and folate metabolism were determined using real-time polymerase chain reaction (RT-PCR) with commercial kits. During follow-up, patients underwent echocardiography on days 1-3 and 7-14, as well as after 12-15 months. LVR was established according to following criteria: 1) combined echocardiographic criterion: a decrease in the left ventricular (LV) ejection fraction <50%, an increase in LV end-diastolic volume ≥20% or end-systolic volume ≥15% based on a comparison of the last and first echocardiography or 2) a clinical criterion: hospitalization for decompensated heart failure. Twentyfour patients attended the final visit, forming comparison and control groups of 12 each. The median follow-up was 392 [383; 406] days.

Results. Significant intergroup differences were identified for two following polymorphisms: rs5370 and rs1126643. In the group of patients with LVR, the frequency of rs5370 GG genotype was 91% (n=10) versus 40% (n=4) in the control group (p=0,024); the frequency of rs1126643 CC genotype was 67% (n=8) versus 8% (n=1), respectively (p=0,009). Multivariate regression analysis revealed that the reference rs5370 GG and rs1126643 CC genotypes may be associated with an increased risk of LVR in STEMI patients with achieved reperfusion, while carriage of an alternative allele (both homozygous and heterozygous) in at least one of these loci was protective.

Conclusion. The reference rs5370 GG and rs1126643 CC genotypes may be part of a genetic predisposition to LVR in STEMI patients with successful reperfusion. These data are not exhaustive and require verification in larger studies.

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