Endothelial glycocalyx integrity of the sublingual microvessels as a predictor of left ventricular performance following STEMI: a 12-month study

Background ST Elevation Myocardial Infarction (STEMI) sufferers display endothelial dysfunction. Purpose We investigated whether endothelial glycocalyx thickness of the sublingual microvessels is affected in STEMI patients and predicts left ventricular (LV) performance at 12 months post event. Methods We recruited 278 STEMI patients and 140 matched controls . We measured: (a) perfused boundary region (PBR) of the sublingual microvessels (range 4 to 25 μm), a marker of endothelial glycocalyx integrity at baseline; (b) Left Ventricular Ejection Fraction (LVEF) and Left Ventricular Global Longitudinal strain (LVGLS), to assess left ventricular performance at 48 hours and at 12 months. Results Compared to controls, STEMI patients had higher PBR4-25 (2.11±0.17μm vs 1.98±0.20μm, p<0.001). In a model including: age, sex, hypertension, diabetes, hyperlipidemia, smoking, number of diseased vessels, location of STEMI (anterior versus other), medication and High-Sensitivity Troponin T (hs-troponin), PBR4-25 remained a significant predictor of LVEF and LVGLS 48 hours post-MI (for LVEF: unstandardized beta coefficient: -4.71, 95% CI:-8.53 – -0.71, p=0.019 and for LVGLS: unstandardized beta coefficient:2.89, 95% CI:1.63 – 4.16, p<0.001)). By ROC analysis, a PBR4-25 cutoff value set at 2.28 (mean + 1 standard deviation) could detect reliably impaired LV EF at 48 hours (AUC:0.80, 95% CI: 0.68 – 0.91; p<0.001; sensitivity:76%, specificity 75%). By multivariable analysis, PBR4-25 remained a significant predictor of in LVEF and LVGLS at 12-month follow-up (for LVEF: unstandardized beta coefficient: -1.38, 95% CI:-1.80 – -0.96, p<0.001 and for LV GLS: unstandardized beta coefficient:-0.66, 95% CI:-1.14 – -0.18, p=0.007). Conclusion Endothelial glycocalyx integrity confers significantly to prediction of myocardial performance after STEMI.