Features of adipokine-mediated myocardial injury in patients with ST-segment elevation myocardial infarction

The aim of the study was to determine the features of adipokine-mediated myocardial injury in patients with ST-elevation myocardial infarction and excess body weight/obesity by assessing the relationship between leptin levels and metabolic disturbances with the severity of atherothrombosis and the severity of the course of acute coronary syndrome according to laboratory and instrumental data. A single-centre prospective cohort study was conducted, which included 120 patients with ST-segment elevation myocardial infarction, who were divided into three groups according to the body mass index: group 1 – excess body weight (25.0-29.9 kg/m², n = 42); group 2 – obesity (≥ 30 kg/m², n = 34); group 3 – normal body mass index (18.5-24.9 kg/m², n = 44). In the obesity group, the highest concentrations of leptin (57.27 ± 4.1 ng/mL) and troponin I (4.09 ± 4.33 ng/mL) were found, which significantly exceeded the indicators of the other groups (ANOVA p < 0.001). A strong positive relationship was established between the body mass index and leptin (r = 0.87; p < 0.001) and between leptin and troponin I (r = 0.46; p = 0.008), which indicated the functioning of a single adipokine-apoptotic axis in the context of myocardial injury. Instrumental methods confirmed a more severe nature of myocardial damage in obesity: lower left ventricular ejection fraction (46.3 ± 6.2%), higher left ventricular mass index (131 ± 22 g/m²), increased wall thickness, the greatest elevation of the ST segment (4.88 ± 2.10 mm; ANOVA p = 0.013), higher frequency of three-vessel lesion (28.6%), and maximal values according to the SYNTAX scale (24.5 ± 8.9 points; p < 0.001). Multiple regression analysis confirmed that the body mass index (β = 0.42; p < 0.001), SYNTAX (β = 0.36; p = 0.004), and reduced ejection fraction (β=–0.33; p= 0.008) are independent predictors of increased levels of troponin I