Plasma asymmetric dimethylarginine and nitric oxide levels on early prognosis in patients with myocardial infarction

OZET Amac: Miyokard infaktusunden (MI) sonra nitrik oksit (NO) metabolizmasindaki anormalliklerin hemodinamik bozukluk ve mortalite ile iliskisi acik degildir. Bu calismada, MI’li hastalarda erken prognoz ile plazma asimertrik dimetil arginin (ADMA) ve NO duzeylerinin iliskisini inceledik. Gerec ve Yontem: Koroner yogun bakim unitesinde yatirilan 59 (9 kadin, 50 erkek, yaslari 32-75) hasta calismaya alindi. Yatis gunu rutin biyokimyasal ve hematolojik incelemeler yapildi, ADMA ve NO degerlerinin olculmesi icin kan alindi. NO nitrat + nitrit (NO metabolitleri) konsantrasyonu olarak spektrofotometrik yontemle 430 nm’de Griess reaksiyonu ile olculdu. ADMA konsantrasyonlari kompetitif ELISA yontemi ile tayin edildi. MI’den bir ay sonra yasayan 56 hastada kardiyak fonksiyon gostergesi olarak sol ventrikul ejeksiyon fraksiyonu (LVEF) degerlendirildi. Bulgular: ADMA ve NO duyeyleri ile yas, cinsiyet, sigara kullanimi, infarktus yeri, hipertansiyon, koroner arter hastaligi, diyabetes mellitus varligi, total kolesterol, trigliserid, LDL-K, lokosit ve C reaktif protein degerleri arasinda iliski bulunmadi. Plazma ADMA duzeyleri NO ile (r=-0.72); ve kreatin kinaz -MB duzeyleri ile (r=-0.37) negatif olarak koreleydi. LVEF ile ADMA ve NO arasinda iliski bulunmadi. Sonuc: Daha onceki calismalarda azalmis NO ve artmis ADMA seviyelerinin koroner arter hastaligi icin bagimsiz risk faktorleri oldugu bildirilmistir. Her ne kadar MI gecirmis hastalarda daha yuksek ADMA duzeyleri gozlendiyse de ADMA ile LVEF ve erken kardiyak olaylar arasinda iliski gorulmedi. Anahtar sozcukler: Asimetrik dimetil arginin; endotel disfonksiyonu; miyokard infarktusu; nitrik oksit; sol ventrikul disfonksiyonu. SUMMARY Objectives: It is unclear whether abnormalities of nitric oxide (NO) are related to hemodynamic dysfunction and mortality in patients after acute myocardial infarction (MI). We investigated the relationship of plasma asymmetric dimethylarginine (ADMA) and NO levels with early prognosis in patients with MI. Methods: Fifty-nine patients (9 females, 50 males, aged 32-75) hospitalized in the Coronary Care Unit were included in the study. Blood samples were obtained on the first day of admission for routine hematological and biochemical tests and for plasma ADMA and NO levels. NO was determined as the concentration of nitrate plus nitrite (NO metabolites) spectrophotometrically at 430 nm using the Griess reaction. ADMA concentrations were determined by competitive ELISA assay. One month after MI, echocardiography was performed on 56 patients who survived, and left ventricular ejection fraction (LVEF) was investigated as a prognostic marker of cardiac function. Results: There was no correlation between ADMA and NO levels with age, gender, smoking, localization of the infarction, history of hypertension, coronary heart disease or diabetes mellitus, and the levels of total cholesterol, triglyceride, lactate dehydrogenase, white blood cells, and Creactive protein. Plasma ADMA concentrations were negatively correlated with NO levels (r=-0.72) and creatine kinase -MB levels (r=-0.37). LVEF had no correlation with ADMA or NO levels (p>0.05). Conclusion: In previous studies, decreased NO and high levels of ADMA were proposed as independent risk factors for coronary artery disease. Although MI patients had higher ADMA levels, they showed no correlation with left ventricular systolic function or early cardiac events.