Key result
High initial serum neprilysin levels (>450 pg/mL) after STEMI were associated with a significantly greater absolute improvement in left ventricular ejection fraction at 7 months (11.3% vs 6.6%, p=0.031).
Why the study?
LV remodeling after STEMI leads to poor outcomes including HF, and neprilysin inhibition improves outcomes in altered LVEF, but the association of neprilysin levels with LV volumes, function, and remodeling after reperfused STEMI was unknown.
Are baseline serum neprilysin levels associated with left ventricular remodeling and function recovery in STEMI patients with successful reperfusion?
Observational (n=68)
Yes
Are baseline serum neprilysin levels associated with left ventricular remodeling and function recovery in STEMI patients with successful reperfusion?
Absolute Event Rate: 11.3% vs 6.6%
p-value: p=0.031
High initial neprilysin levels in STEMI patients without heart failure are associated with lower baseline LVEF but greater recovery of contractility at 7 months follow-up.
Serum neprilysin may mark post-STEMI remodeling risk; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome, including heart failure (HF). Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF). METHODS: We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion and no clinical sign of HF. Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and after a median follow-up of 7 months. We compared 3 groups: a group with a low-level of plasma neprilysin (< 125 pg/mL, i.e. the lower limit of detection of the assay) and the two other groups were defined as being below or above the median value of the remaining samples. RESULTS: Median age was 58.5 ± 12.8 years and 56 (82.4%) were men. Median LVEF was 45.0 ± 8.5%. Baseline characteristics were comparable between groups (low-level of neprilysin group [≤125 pg/mL, n = 38], medium-level of neprilysin group [126-450 pg/mL, n = 15] and a high-level group [> 450 pg/mL, n = 15]). At baseline there was a non-significant trend towards lower end-diastolic volume (p = 0.07) but significantly lower LVEF in the high neprilysin group (46.4 ± 8.3%, 47.1 ± 8.1% and 39.1 ± 6.9%, p < 0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p = 0.022 for relative change in LVEF and 6.6 ± 7.3%, 3.6 ± 9.0% and 11.3 ± 8.4%, p = 0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0 ± 8.9%, 50.6 ± 9.7% and 50.4 ± 9.9%, p = 0.55). CONCLUSIONS: Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up. Future studies will have to assess the role of neprilysin in the setting of STEMI and the potential benefit of its blockade.
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Legallois et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=68). High serum neprilysin levels (> 450 pg/mL) vs. Low serum neprilysin levels (≤ 125 pg/mL) was evaluated on Absolute change in left ventricular ejection fraction (LVEF) at follow-up (p=0.031). High initial serum neprilysin levels (>450 pg/mL) after STEMI were associated with a significantly greater absolute improvement in left ventricular ejection fraction at 7 months (11.3% vs 6.6%, p=0.031).
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