Sustained Increase in Serum Glial Fibrillary Acidic Protein after First ST-Elevation Myocardial Infarction
Abstract
:1. Introduction
2. Results
2.1. Characteristics of Included Patients
2.2. Course of GFAP and NfL after First STEMI
2.3. Clinical Correlates
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Selection of Patients
4.3. Study Flow
4.4. Ultrasensitive Immunoassays for GFAP/NfL
4.5. Cardiac Magnetic Resonance Imaging
4.6. Statistical Evaluation
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Patients (n = 45) | ΔGFAP ≤ 0 (n = 9) | ΔGFAP > 0 (n = 36) | p | |
---|---|---|---|---|
Age (years) | 56 (49, 65) | 56 (51, 66) | 55 (46, 65) | 0.399 |
Female sex (%) | 5 (11.1%) | 1 (11.1%) | 4 (11.1%) | >0.999 |
Body mass index (kg/m2) | 27 (24, 29) | 26 (24, 30) | 27 (24, 29) | 0.744 |
Arterial hypertension * | 17 (37.8%) | 4 (44.4%) | 13 (36.1%) | 0.645 |
Diabetes mellitus † | 7 (15.6%) | 2 (22.2%) | 5 (13.9%) | 0.537 |
Dyslipidemia ‡ | 8 (17.8%) | 1 (11.1%) | 7 (19.4%) | 0.559 |
Current smoker | 17 (37.8%) | 1 (11.1%) | 16 (44.4%) | 0.181 |
Previous coronary artery disease | 10 (22.2%) | 2 (22.2%) | 8 (22.2%) | >0.999 |
Previous myocardial infarction | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | >0.999 |
Atrial fibrillation | 2 (4.4%) | 1 (11.1%) | 1 (2.8%) | 0.497 |
Peripheral vascular disease | 4 (8.9%) | 0 (0.0%) | 4 (11.1%) | 0.295 |
Pain-to-balloon time (min) | 280 (123, 592) | 210 (114, 784) | 285 (131, 593) | 0.532 |
Culprit vessel: | ||||
- Left anterior descending | 19 (42.2%) | 4 (44.4%) | 15 (41.7%) | 0.880 |
- Circumflex artery | 10 (22.2%) | 2 (22.2%) | 8 (22.2%) | >0.999 |
- Right coronary artery | 16 (35.6%) | 3 (33.3%) | 13 (36.1%) | 0.876 |
Stent implantation | 43 (95.6%) | 9 (100.0%) | 34 (94.4%) | 0.469 |
Classification of coronary artery disease | ||||
- 1-vessel | 27 (60.0%) | 4 (44.4%) | 23 (63.9%) | 0.287 |
- 2-vessel | 14 (31.1%) | 3 (33.3%) | 11 (30.6%) | 0.872 |
- 3-vessel | 4 (8.9%) | 2 (22.2%) | 2 (5.6%) | 0.116 |
Peak creatine kinase (U/L) | 560 (302, 1136) | 239 (122, 659) | 717 (402, 1326) | 0.096 |
Peak troponin T (pg/nL) | 2045 (950, 2952) | 1334 (452, 2447) | 2395 (1000, 3372) | 0.145 |
Peak lactate dehydrogenase (U/L) | 530 (366, 657) | 372 (236, 607) | 533 (375, 734) | 0.117 |
End-diastolic volume (mL/m2) d 7–9 | 87 (80, 97) | 90 (83, 94) | 86 (79, 100) | 0.924 |
Left ventricular ejection fraction (%) d 7–9 | 54 (46, 58) | 55 (43, 59) | 54 (47, 58) | 0.836 |
Relative infarction size (%) d 7–9 | 15.5 (9.4, 20.0) | 10.4 (2.7, 16.1) | 16.2 (11.1, 21.6) | 0.047 |
End-diastolic volume (mL/m2) 12 m | 84 (74, 96) | 85 (75, 104) | 84 (73, 96) | 0.593 |
Left ventricular ejection fraction (%) 12 m | 53 (47, 59) | 57 (44, 62) | 53 (47, 58) | 0.716 |
Relative infarction size (%) 12 m | 8.5 (6.2, 14.8) | 7.2 (2.4, 15.0) | 8.5 (6.6, 14.8) | 0.387 |
Spearman’s Rho (ρ) | GFAP 0–4 d (pg/mL) | GFAP 12 m (pg/mL) | ΔGFAP (pg/mL) | NfL 0–4 d (pg/mL) | NfL 12 m (pg/mL) | ΔNfL (pg/mL) |
---|---|---|---|---|---|---|
Age (years) | 0.56 * | 0.61 * | 0.15 | 0.78 * | 0.74 * | −0.15 |
Systolic blood pressure at admission (mmHg) | −0.19 | 0.04 | 0.23 | −0.14 | 0.02 | 0.18 |
Diastolic blood pressure at admission (mmHg) | −0.14 | 0.01 | 0.11 | −0.20 | −0.08 | 0.18 |
Heart rate at admission (1/min) | −0.14 | −0.13 | 0.10 | −0.15 | −0.08 | 0.11 |
Pain-to-balloon time (min) | 0.13 | 0.10 | −0.06 | −0.16 | −0.18 | −0.09 |
Peak creatine kinase (U/L) | −0.14 | 0.03 | 0.25 | −0.19 | 0.04 | 0.39 * |
Peak troponin T (pg/mL) | 0.08 | 0.10 | 0.03 | 0.00 | 0.08 | 0.00 |
Peak lactate dehydrogenase (U/L) | 0.05 | 0.14 | 0.17 | −0.03 | 0.07 | 0.08 |
Peak C-reactive protein (mg/dL) | 0.19 | 0.13 | −0.11 | 0.23 | 0.09 | −0.23 |
Peak leucocytes (103/µL) | −0.17 | −0.10 | 0.11 | −0.04 | 0.02 | 0.00 |
Normalized end-diastolic volume (mL/m2) d 7–9 | 0.08 | 0.02 | −0.07 | −0.09 | −0.15 | −0.14 |
Left-ventricular ejection fraction (%) d 7–9 | −0.24 | −0.21 | 0.02 | −0.18 | −0.26 | −0.06 |
Relative infarction size (%) d 7–9 | −0.02 | 0.19 | 0.41 * | 0.05 | 0.16 | 0.13 |
Day 0–4 | 12 Months | Δ12 m—d 0–4 | ~ΔGFAP | p Value | |
---|---|---|---|---|---|
Glial fibrillary acidic protein (pg/mL) | 64 (47, 90) | 73 (53, 113) | 10 (1, 23) * | - | |
Neurofilament light chain (pg/mL) | 11 (7, 15) | 10 (7, 14) | 0 (−2, 1) | 0.32 * | 0.030 |
Natrium (mmol/L) | 139 (137, 140) | 140 (138, 141) | 1 (−1, 2) * | −0.14 | ns |
Potassium (mmol/L) | 4.2 (4.0, 4.4) | 4.4 (4.2, 4.6) | 0.2 (0.0, 0.4) * | 0.03 | ns |
Estimated GFR (mL/min/1.73 m2) | 91 (80, 106) | 82 (72, 99) | −7 (−14, 3) * | −0.14 | ns |
Urea (mg/dL) | 31 (25, 38) | 31 (26, 37) | 0 (−7, 7) | 0.13 | ns |
Uric acid (mg/dL) | 5.2 (4.5, 6.0) | 6.0 (5.0, 6.6) | 0.7 (0.0, 1.4) * | 0.17 | ns |
Cholesterol (mg/dL) | 190 (165, 211) | 161 (145, 190) | −25 (−60, 11) * | −0.08 | ns |
Low-density lipoprotein (mg/dL) | 95 (78, 114) | 82 (66, 101) | −11 (−42, 5) * | 0.03 | ns |
High-density lipoprotein (mg/dL) | 39 (33, 46) | 45 (38, 59) | 5 (2, 9) * | −0.02 | ns |
Triglycerides (mg/dL) | 128 (105, 162) | 162 (98, 195) | 45 (−12, 108) * | −0.14 | ns |
Aspartate aminotransferase (U/L) | 48 (33, 93) | 28 (21, 32) | −21 (−155, −4) | −0.07 | ns |
Alanine aminotransferase (U/L) | 45 (31, 65) | 30 (20, 34) | −19 (−27, 3) | −0.23 | ns |
γ-glutamyltransferase (U/L) | 44 (28, 70) | 32 (19, 38) | −3 (−53, 4) | −0.22 | ns |
Lactate dehydrogenase (U/L) | 530 (366, 657) | 198 (175, 240) | −293 (−491, −108) * | −0.15 | ns |
Creatine kinase (U/L) | 560 (302, 1136) | 113 (82, 165) | −426 (−975, −95) * | −0.19 | ns |
NT-proBNP (pg/mL) | 844 (627, 1368) | 133 (48, 291) | −755 (−1329, −403) * | −0.02 | ns |
Troponin T (pg/mL) | 2044 (950, 2952) | 6 (5, 9) | −2037 (−2946, −945) * | −0.03 | ns |
Complement factor C3c (mg/dL) | 121 (107, 132) | 118 (105, 131) | −3 (−14, 8) | −0.02 | ns |
Albumin (g/dL) | 4.2 (3.9, 4.3) | 4.6 (4.4, 4.9) | 0.5 (0.3, 0.8) * | 0.00 | ns |
Hemoglobin (g/dL) | 13.9 (13.0, 15.1) | 14.6 (13.8, 15.5) | 0.8 (0.2, 1.7) * | −0.09 | ns |
Hematocrit (%) | 41 (38, 43) | 43 (41, 45) | 3 (0, 5) * | −0.16 | ns |
Thrombocytes (103/µL) | 242 (189, 288) | 235 (189, 285) | 3 (−23, 19) | 0.12 | ns |
Leucocytes (103/µL) | 9.2 (8.1, 10.9) | 6.3 (5.2, 7.2) | −2.8 (−4.2, −1.9) * | −0.14 | ns |
HbA1c (%) | 5.6 (5.4, 6.7) | 5.7 (5.4, 6.0) | 0.0 (−0.2, 0.3) | 0.15 | ns |
C-reactive protein (mg/dL) | 1.7 (0.7, 6.2) | 0.1 (0.0, 0.2) | −1.6 (−6.1, −0.6) * | 0.12 | ns |
Inclusion Criteria |
---|
Age ≥ 18 years and written informed consent |
No previous history of myocardial infarction |
New onset of chest pain in the past 7 days |
Confirmed myocardial infarction in cardiac catheterization |
Fulfillment of STEMI criteria: |
- Either ST-segment elevations in at least two adjacent leads |
- ST-segment elevations ≥ 0.1 mV in the extremity leads |
- ST-segment elevations ≥ 0.2 mV in the chest wall leads |
- Or new onset left bundle branch block with matching clinic |
Exclusion criteria |
Tumor disease or other critical illness with a life expectancy of <1 year |
Terminal renal failure or hemodialysis |
Rheumatologic disease with the need for immunomodulatory drugs |
Autoimmune disease with the need for immunomodulatory drugs |
Congenital neuromuscular disease |
Myasthenia gravis |
Graves’ disease |
Incapacity to consent |
Sociological, psychological, mental, or other limitations |
Continued alcohol or drug abuse |
Pregnancy or lactation |
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Traub, J.; Grondey, K.; Gassenmaier, T.; Schmitt, D.; Fette, G.; Frantz, S.; Boivin-Jahns, V.; Jahns, R.; Störk, S.; Stoll, G.; et al. Sustained Increase in Serum Glial Fibrillary Acidic Protein after First ST-Elevation Myocardial Infarction. Int. J. Mol. Sci. 2022, 23, 10304. https://doi.org/10.3390/ijms231810304
Traub J, Grondey K, Gassenmaier T, Schmitt D, Fette G, Frantz S, Boivin-Jahns V, Jahns R, Störk S, Stoll G, et al. Sustained Increase in Serum Glial Fibrillary Acidic Protein after First ST-Elevation Myocardial Infarction. International Journal of Molecular Sciences. 2022; 23(18):10304. https://doi.org/10.3390/ijms231810304
Chicago/Turabian StyleTraub, Jan, Katja Grondey, Tobias Gassenmaier, Dominik Schmitt, Georg Fette, Stefan Frantz, Valérie Boivin-Jahns, Roland Jahns, Stefan Störk, Guido Stoll, and et al. 2022. "Sustained Increase in Serum Glial Fibrillary Acidic Protein after First ST-Elevation Myocardial Infarction" International Journal of Molecular Sciences 23, no. 18: 10304. https://doi.org/10.3390/ijms231810304