Predictive value of HIF-1α for left ventricular remodeling following an anterior ST-segment elevation myocardial infarction.

Background: Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.

Objective: To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.

Methods: In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20% was defined as LVR.

Results: The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95% CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95% CI: 0.7067 to 0.8744; P < 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95% CI: 0.7345 to 0.8896; P < 0.0001).

Conclusion: These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.