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Arginine Vasopressin Plays a Role in Microvascular Dysfunction After ST-Elevation Myocardial Infarction

Lookup NU author(s): Dr Ayman Al-atta, Dr Luke Spray, Dr Ashfaq Mohammed, Professor Ioakim SpyridopoulosORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2023 The Authors.BACKGROUND: Coronary microvascular dysfunction (CMD) predicts mortality after ST-elevation–myocardial infarction (STEMI). Arginine vasopressin (AVP) may be implicated, but data in humans are lacking, and no study has investigated the link between arginine vasopressin and invasive measures of CMD. METHODS AND RESULTS: We invasively assessed CMD in 55 patients with STEMI treated with primary percutaneous coronary intervention (PPCI), by measuring the index of microcirculatory resistance after PPCI. In a separate group of 45 patients with STEMI/PPCI, recruited for a clinical trial, we measured infarct size and microvascular obstruction with cardiac magnetic resonance (CMR) imaging at 1 week and 12 weeks post-STEMI. Serum copeptin was measured at 4 time points before and after PPCI in all patients with STEMI. Plasma copeptin levels fell from 92.5 pmol/L before reperfusion to 6.4 pmol/L at 24 hours. Copeptin inversely correlated with diastolic, but not systolic, blood pressure (r=−0.431, P=0.001), suggesting it is released in response to myocardial ischemia. Persistently raised copeptin at 24 hours was correlated with higher index of microcirculatory resistance (r=0.372, P=0.011). Patients with microvascular obstruction on early CMR imaging showed a trend toward higher admission copeptin, which was not statistically significant. Copeptin levels were not associated with infarct size on either early or late CMR. CONCLUSIONS: Patients with CMD after STEMI have persistently elevated copeptin at 24 hours, suggesting arginine vasopressin may contribute to microvascular dysfunction. Arginine vasopressin receptor antagonists may represent a novel therapeutic option in patients with STEMI and CMD.

Publication metadata

Author(s): Al-Atta A, Spray L, Mohammed A, Shmeleva E, Spyridopoulos I

Publication type: Article

Publication status: Published

Journal: Journal of the American Heart Association

Year: 2023

Volume: 12

Issue: 18

Print publication date: 19/09/2023

Online publication date: 08/09/2023

Acceptance date: 04/08/2023

Date deposited: 02/10/2023

ISSN (electronic): 2047-9980

Publisher: American Heart Association Inc.

URL: https://doi.org/10.1161/JAHA.123.030473

DOI: 10.1161/JAHA.123.030473

PubMed id: 37681545

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