Abstract 11099: Beneficial Effects of Statin Treatment on Coronary Microvascular Dysfunction and Left Ventricular Remodeling in Patients with Acute Myocardial Infarction
Purpose: Elevated levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, have been reported to relate to decreased myocardial flow reserve (MFR). We investigated whether standard statin treatment could improve microvascular dysfunction with changes in serum ADMA levels and attenuate left ventricular (LV) remodeling in patients with acute myocardial infarction (AMI).
Method: Forty patients with successful reperfusion following AMI (30 men, mean 65 years) were assigned to either statin group (Group S; n = 21, 6 atorvastatin, 5 pitavastatin, 2 fluvastatin, 7 pravastatin, 1 rosuvastatin) or non-statin group (Group NS; n = 19), according to Japan atherosclerosis society guidelines for prevention of atherosclerotic cardiovascular diseases. 13N-ammonia positron emission tomography with adenosine tri-phosphate was performed to assess the MFR in the infarct-related area (IRA) at mean 15.9 days after the onset. LV end-diastolic volume index (LVEDVI) were calculated using left ventriculography at 6 months after the onset. Serum ADMA levels on admission and 1 month after the onset were measured in 21 of all patients by ELISA methods.
Results: There were no differences in lipid profile at chronic period, peak creatinine kinase (Group S vs. Group NS ; 2868 ± 2024 mg/dl vs. 3915 ± 3719 mg/dl, p = NS.) and defect score on 99mTc-tetrofosmin myocardial perfusion imaging (21.7 ± 13.9 vs. 22.1 ± 12.2, p = NS.) between the two groups. The mean MFR in the IRA was significantly higher in Group S than Group NS (2.27 ± 0.54 vs. 1.91 ± 0.43, p = 0.022). In chronic period, Group NS patients had greater LVEDVI at 6 months than Group S (87.4 ± 33.7 mL/m2 vs. 56.6 ± 12.2 mL/m2, p = 0.0006). Moreover, the MFR in the IRA were inversely correlated with the LVEDVI at 6 months (r = −0.404, p = 0.0119). During the follow-up period, serum ADMA levels of Group NS patients significantly increased from 0.43 ± 0.12 μmol/L to 0.52 ± 0.14 μmol/L (p = 0.0186), whereas those of Group S patients did not change over time (from 0.57 ± 0.11 μmol/L to 0.61 ± 0.12 μmol/L, p = NS).
Conclusion: Statin treatment may provide beneficial effects in terms of attenuating LV remodeling after MI, which may be associated with restoring coronary microvascular function via endogenous nitric oxide.
- © 2010 by American Heart Association, Inc.