doiSerbia

Association between serum concentration of parathyroid hormone and left ventricle ejection fraction, and markers of heart failure and inflammation in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention

Vukotić Snježana (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Ristić Anđelka (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Đenić Nemanja (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Ratković Nenad (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Romanović Radoslav (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)
Vujanić Svetlana (Military Medical Academy, Institute of Medical Biochemistry, Belgrade)
Obradović Slobodan (Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade)

Background/Aim. Previous studies have shown increased serum concentration of parathyroid hormone (PTH) in acute myocardial infarction and heart failure. In this study we examined the relation-ships between parathyroid hormone status and biochemical markers of myocardial injury and heart failure, as well as electrocardio-graphic (ECG) and echocardiographic indicators of infarction size and heart failure. Methods. In 390 consecutive patients with ST segment elevation myocardial infarction (STEMI), average age 62 ± 12 years, laboratory analysis of serum concentrations of creatine kinase MB isoenzyme (CK-MB), C-reactive protein (CRP) and in-tact PTH and plasma concentration of brain natriuretic peptide (BNP) were done during the first three days after admission. All patients were treated with primary percutaneous coronary intervention (PCI). Exclusion criterion was severe renal insufficiency (glomerular filtration rate ≤ 30 mL/min). Serum concentration of PTH was measured on the 1st, 2nd and, in some cases, on the 3rd morning after admission and maximum level of PTH was taken for analysis. Patient cohort was divided into four groups according to quartiles of PTH maximum serum concentration (I ≤ 4.4 pmol/L; II > 4.4 pmol/L and < 6.3 pmol/L; III ≥ 6.3 pmol/L and < 9.2 pmol/L; IV ≥ 9.2 pmol/L). Selvester’s ECG score, left ventricle ejection fraction and wall motion index (WMSI) were determined at discharge between 5–14 days after admission. Results. We found that LVEF at discharge significantly decreased (p < 0.001) and WMSI at discharge and ECG Selvester´s score significantly increased across the quartiles of PTH max. level (p < 0.001 for both parameters). BNP, CRP and CK-MB isoenzyme level significantly increased across the quartiles of PTH max. level (p < 0.001; p < 0.001 and p = 0.004, retrospectively). Conclusion. The patients in the 4th quartile of PTH had significantly lower LVEF and higher WMSI and Selvester’s ECG score at discharge. This group of patients also had higher levels of BNP, CRP and CK-MB in blood in the early course of STEMI.

Keywords: parathyroid hormone, st elevation myocardial infarction, heart failure, biomarkers