Highlights

The developed prognostic model for assessing the risk of cardiac fibrosis in patients with STEMI with HFmrEF and HFpEF is promising from the point of view of scientific and clinical potential because similar models for predicting the risk of cardiac fibrosis in patients with index MI are not currently validated. The developed scale includes such parameters as age, LVEF, COL-1, BMI, MMP-2. The scale can be used in patients with HFmrEF and HFpEF phenotypes. Identification of patients at high risk of myocardial fibrosis will allow choosing the appropriate treatment method.

Aim. To develop a prognostic model for assessing the risk of cardiac fibrosis (CF) in patients with preserved left ventricular ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF) a year after ST-segment elevation myocardial infarction (STEMI) based on clinical, instrumental and biochemical data.

Methods. The prospective cohort study included 100 STEMI patients with HFmrEF (LVEF 40–49%) and with HFpEF (50% or more). Echo was performed in all patients on the 1st, 10–12th day and a year after onset of STEMI. Upon admission to the hospital and on the 10–12th day after the onset of the disease, the following serum biomarker levels were determined: those associated with changes in the extracellular matrix; with remodeling and fibrosis; with inflammation, and with neurohormonal activation. At the 1-year follow-up visit, 84 patients underwent contrast-enhanced MRI to assess fibrotic tissue percentage relative to healthy myocardium.

Results. The distribution of patients by HFmrEF and HFpEF phenotypes during follow-up was as follows: HFmrEF on the 1st day – 27%, 10th day – 12%, after a year – 11%; HFpEF on the 1st day – 73%, 10th day – 88%, after a year – 89%. According to cardiac MRI at the follow-up visit (n = 84), the median distribution of fibrotic tissue percentage was 5 [1.5; 14]%. Subsequently, the threshold value of 5% was chosen for analysis: CF≥5% was found in 38 patients (the 1st group), whereas CF<5% was noted in 46 patients (the 2nd group). When analyzing the intergroup differences in biological marker concentrations in the in-patient setting and at the annual follow-up, it was determined that the most significant differences were associated with “ST-2” (1st day) that in the “CF≥5%” group was 11.4 ng/mL higher on average compared to the “CF<5%” group (p = 0.0422); “COL-1” (1st day) that in the “CF≥5%” group was 28112.3 pg/mL higher on average compared to the “CF<5%” group (p = 0.0020), and “NT-proBNP” (12th day) that in the “CF<5 %” group was 1.9 fmol/mL higher on average compared to the “CF≥5%” group (p = 0.0339). Certain factors (age, LVEF (12th day), collagen-1 (1st and 12th day), body mass index, matrix metalloproteinase-2 (12th day) were determined and included in the prognostic model for assessing the risk of CF a year after the STEMI (AUC ROC 0.90, Chi-square test <0.0001).

Conclusion. Prognostic model (scale) based on factors such as age, left ventricular ejection fraction (12th day), collagen-1 (1st and 12th day), body mass index, matrix metalloproteinase-2 (12th day) shows high prognostic power and enables identification of patients with HFmrEF and HFpEF phenotypes and at high risk of cardiac fibrosis a year after STEMI.