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Arginine, ornithine, citrulline, asymmetric dimethylarginine (ADMA) and proline plasma levels were measured using liquid chromatography and tandem mass spectrometry in 70 consecutive STEMI patients upon admission and at 6-month follow-up and were compared with left ventricular function, volumes, and infarct characteristics determined by cardiac magnetic resonance imaging, and with 5-year clinical outcomes. Baseline median concentration of arginine was higher by 49% (<jats:italic>P<\/jats:italic>\u2009=\u20090.002) when compared to 6-month measurements and was correlated with an ischemia risk area (R\u2009=\u20090.34, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) and infarct size (R\u2009=\u20090.33, <jats:italic>P<\/jats:italic>\u2009=\u20090.006). Following ischemia median citrulline\/arginine index decreased when compared with 6-month result (<jats:italic>P<\/jats:italic>\u2009=\u20090.002), while citrulline\/ornithine and arginine\/ADMA ratios maintained unchanged indicating a shift of arginine metabolism from nitric oxide synthase (NOS) towards arginase. The 6-month arginine concentration reached the area under the ROC curve of 0.67 (95% confidence interval 0.54\u20130.81) for prediction of death, myocardial infarction or heart failure hospitalization and its value of\u2009&lt;\u200929\u00a0\u00b5M was associated with lower event free survival (<jats:italic>P<\/jats:italic>\u2009=\u20090.02). In STEMI patients, during ischemia conversion of elevated plasma arginine was shifted from NOS towards arginase. Decreased 6-month arginine concentrations were associated with worse long-term outcomes.<\/jats:p>","DOI":"10.1038\/s41598-020-80230-3","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T11:13:01Z","timestamp":1610104381000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["The shifted balance of arginine metabolites in acute myocardial infarction patients and its clinical relevance"],"prefix":"10.1038","volume":"11","author":[{"given":"Patrycja","family":"Molek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel","family":"Zmudzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Wlodarczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadwiga","family":"Nessler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-3694","authenticated-orcid":false,"given":"Jaroslaw","family":"Zalewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,8]]},"reference":[{"key":"80230_CR1","doi-asserted-by":"publisher","first-page":"2579S","DOI":"10.3945\/jn.115.226621","volume":"146","author":"SM Morris Jr","year":"2016","unstructured":"Morris, S. 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