Abstract 1364: Impact of the ApoB/A1-Ratio on the Prediction of the Elevation of Left Ventricular Filling Pressure After a First STEMI
Background The non-fasting ApoB/ApoA1-ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infarction (AMI) (Lancet 2008; 32.224). The AMORIS study prospectively revealed that the strongest single lipoprotein-related risk factor for fatal AMI was the Apo-B/Apo-A-I ratio in a large cohort by 10.3 years follow up. (AJC 2006; 97.243). The aim of this study was to explore the impact of ApoB/A1 on the damage to cardiac function after a first ST-elevation AMI (STEMI).
Methods 241 consecutive patients (age=63.8±11.9 years, male=197 patients, culprit lesions: LMT=3, LAD=109, RCA=103, LCx=26) underwent successful emergent PCI within 12 hours of onset. Blood sampling, including apolipoproteins, was obtained at their emergent admission. They underwent echocardiography 2 weeks after onset. We examined the tissue Doppler imaging, then calculated the early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e′) - a ratio that strongly correlates with mean left ventricular filling pressure. Exclusion criteria were those with chronic kidney disease (CKD) at Stage 4 and 5 (eGFR <30 ml/min), anemia (Hemoglobin<10g/dl), significant valvular heart disease, prior MI, non-STEMI, A-C bypass and atrial fibrillation. Patients were followed up for 36 months.
Results There were significant relationships between the Apo-B/Apo-A-1 ratio and E/e′ (r=0.20, p<0.001) and between Apo-B and E/e′ (r=0.15, p<0.05). However, the other apolipoproteins and conventional lipid profiles did not show associations with echocardiographical parameters, including E/e′. Furthermore, the Apo-B/Apo-A-1 ratio was the most powerful predictor of the progression of CKD (when eGFR decreased from baseline >20%) after 36 months(Odds ratio=3.55,95%CI:1.22–10.37).
Conclusion The value of the Apo-B/A-1-ratio on admission could predict the elevation of LV filling pressure 2 weeks after a first STEMI onset. The higher the Apo-B/A-1-ratio on admission, the greater the LV damage from STEMI, despite patients having successfully received early reperfusion therapy. These results might explain why the higher Apo-B/Apo-A-I ratio is frequently followed by fatal AMI.