الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Despite improvements in the treatment of myocardial infarction , 30% of patients show left ventricular (LV) remodeling post-MI. It is expected that almost 30% of the patients will have an LV ejection fraction (LVEF %) below 40% at 6 months post MI. We conducted this study to identify the diagnostic role of miRNA-133a in acute ST-segment elevation MI (STEMI), and to study the differences in miRNA-133a expression between patients with LV remodeling and those without, as well as its ability to predict the occurrence of major adverse cardiovascular events (MACE), following primary percutaneous coronary intervention (1ry PCI) for acute STEMI.
A total of 100 AMI patients were enrolled for the study. The gender ratio was 85:15 (male: female). Another 50 healthy volunteers were recruited to provide a direct comparison of miRNA-133a levels with AMI patients.
Patients with cardiomyopathies, congenital heart disease, atrial fibrillation, and severe valvular diseases, Patients planning for CABG, and patients with severe chronic systemic diseases, such as: chronic kidney disease, hepatic impairment, cancer were excluded from the study.
Relative expression of miRNA-133a level was significantly higher in patients with AMI (44.22 ±10.98) than healthy controls (4.31 ±1.58), p <0.001 with cutoff value of 15.5 for miRNA-133a expression, is 100% sensitive and specific for the diagnosis of acute STEMI.
Our results showed strong positive correlation between miRNA-133a expression and high sensitive cardiac troponin ; r: 0.783. At 6 months follow-up, 39 patients (39%) were classified as having LV remodeling and 54 (54%) patients were classified as having no remodeling .There was no significant difference in miRNA-133a patients with LV remodeling (44.4±12.2) than in patients without LV remodeling (44.2±10.3), p-value 0.91.
miRNA-133a had no significant difference in patients who died than those who survived, p <0.683, in patients with early complications versus those without, p <0.406, and in those with late complications versus those without late complications , p = 0.661. The study showed that the most powerful factor that can predict LV remodeling was LVEDV (OR= 1.053).
In patients with LV remodeling; the LV ejection fraction (LVEF%) was significantly lower, while the LV end diastolic volume (LVEDV) and the LV end systolic volume (LVESV) were significantly higher at six months follow-up compared to the time of admission. On the other hand, the GLS was impaired all through after MI in those patients, without significant difference between the 6 months follow-up and the admission measures may be due to the ability of GLS to detect early loss of myocardial contractility.
In patients without LV remodeling; the LVEF%, LVEDV, and LVESV were statistically similar at six months and at admission, while the GLS was significantly better at 6 months than at admission may be due to improvement of myocardial stunning.
27 patients (27%) in group I developed MACE (death, myocardial infarction ,coronary revascularization, stroke and hospitalization because of heart failure) .
There was no statistically significant difference in the expression level of miRNA-133a in patients developed MACE .