V.I. Tseluyko, L.M. Yakovleva, O.E. Matuzok Relationship between asymmetric dimethylarginine and clinical, laboratory, ultrasonic parameters in patients with myocardial infarction after intravenous fibrinolysis

The aim – to evaluate asymmetric dimethylarginine (ADMA) concentration and its possible relationship with clinical features, anamnesis, laboratory parameters, cardiac ultrasound in patients with ST-elevation myocardial infarction after intravenous fibrinolysis.

Material and methods. We examined 40 patients with myocardial infarction after intravenous fibrinolysis. Blood sampling was performed at admission. C-reactive protein (CRP) concentration was accessed. Quantitative determination of ADMA concentration was performed with high-performance liquid chromatography. Cardiac ultrasound was done in all patients. Fibrinolysis efficacy was evaluated according to the ECG criteria.

Results. ADMA concentration in examined patients was 0.1–4.94 mkmol/l. Patients were divided into four groups according to ADMA quartiles (increase of ADMA concentration from group I to group IV). All patients in group IV were smokers, the difference was significant in groups I and II (P=0.04). Time to fibrinolysis was significantly higher in group IV than in groups II (P=0.02) and III (P=0.04). Mean ADMA concentration was significantly higher in patients with anterior compared to patients with inferior infarction (1.79±1.5 and 0.8±0.75 mkmol/l, respectively, Р=0.02). In correlation analysis ADMA level was related to history of smoking, high-sensitive CRP and glycemia level at admission, time to fibrinolysis, heart rate on the second day of infarction, and ultrasonic parameters – end-diastolic volume (EDV), and-systolic volume and ejection fraction. Fibrinolysis was significantly less effective in patients with higher ADMA level.

Conclusion. Significant increase of ADMA level was found in presence of smoking, longer of time to fibrinolysis and in anterior localization of infarction. ADMA level increase was associated with increase of hsCRP level, younger age, EDV and admission glycemia increase, decrease of glomerular filtration rate and body mass index, increase of time to fibrinolysis (regression analysis). Fibrinolysis was significantly less effective in patients with higher ADMA level.

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