Supervisors info:
Κουσκούνη Ευαγγελία, Ομότιμη Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ, Επιβλέπουσα
Ιακωβίδου Νικολέττα, Αναπληρώτρια Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ
Χαλκιάς Αθανάσιος, Επίκουρος Καθηγητής, Τμήμα Ιατρικής, Πανεπιστήμιο Θεσσαλίας
Summary:
BACKROUND: Acute coronary syndromes are one of the major health problems worldwide, as they are implicated in high morbidity and mortality rates. In recent years, scientific interest has been focused on investigating the mechanisms of arrhythmogenesis following acute myocardial infarction, as well as finding factors to prevent them. Endothelin-1 exhibits important electrophysiological properties and contributes to the development of life-threatening arrhythmias. In addition, endothelin-1 production leads to activation of the sympathetic nervous system, resulting in the promotion of arrhythmias during myocardial ischemia.
OBJECTIVE: The purpose of this study is to investigate the pathophysiological processes performed during the acute phase of coronary syndrome involving endothelin-1. Furthermore, the present work aims to correlate these mechanisms with the development of new antiarrhythmic agents, as well as their effectiveness in preventing arrhythmogenesis after acute coronary syndromes.
METHODS: After a systematic review of the literature, all trials were collected to investigate the role of endothelin-1 receptor antagonists in ventricular arrhythmogenesis following acute myocardial infarction. In comparison, the mean overall duration of ventricular tachyarrhythmias, infarct size, and mortality were studied as endpoints. The presentation and description of the data, as well as the construction of the mathematical model to calculate the statistical significance of this relationship were made using the STATA 11.0 program.
RESULTS: The meta-analysis included 10 trials and a total of 398 rats, with a different follow-up period, with the majority of studies having a 24-hour follow-up. The weighted mean difference for the total episodes duration was found to be 18.65 (95% ΔE: 1.06; 36.25, p = 0.038) which means that the episodes duration was significantly higher in the drug group compared to the control group. Also, the weighted mean difference for infarct size was found to be -2.97 (95% DE: -6.39; -0.83, p = 0.011) which means that the mean infarct size was significantly smaller in this group compared to the control group. In contrast, the relative risk of the mortality was found to be 1.35 (95% DE: 0.62-2.94, p = 0.452), which means that there was no significant difference in the risk of death between the control and the drug group.
CONCLUSIONS: Acute myocardial infarction is one of the leading causes of death worldwide. Acute obstruction of the coronary vessels often causes the generation of ventricular tachyarrhythmias, which in large part lead to sudden cardiac death. The purpose of this study was to analyze the role of ET-1 in ventricular arrhythmogenesis during AMI, using systematic review and meta-analysis. Three endpoints were studied, which ere total mean duration of VAs, infarct size-IS, and mortality. The meta-analysis of the studies included, which have significant heterogeneity, showed that the ET-1 receptor antagonist group of rats exhibited longer VAs and shorter IS, but showed no significant difference in mortality.
Keywords:
Endothelin, Arrhythmogenesis, Arrhythmias, Endothelin-1, Ventricular arrhythmias
